Sr. Consulting Manager

Job Summary

Responsibilities

• Drive complex consulting engagements in the payer domain to deliver measurable improvements in claims management provider contracting and member services while aligning outcomes with organizational goals and client expectations.
• Guide cross functional consulting teams to define payer business problems develop structured hypotheses and design data backed solutions that advance care affordability and administrative efficiency.
• Manage end to end engagement lifecycles from discovery and assessment through solution design execution and benefits realization ensuring delivery practices meet quality standards and regulatory obligations in payer operations.
• Collaborate with payer client executives and internal stakeholders to prioritize consulting initiatives refine value propositions and translate strategic objectives into actionable roadmaps with clear milestones and success metrics.
• Direct the development and refinement of operating models for health plans including enrollment processes utilization management workflows and grievance and appeals handling to enhance member satisfaction and compliance.
• Coordinate analytical reviews leveraging claims data authorization records and provider performance indicators to identify cost containment opportunities fraud waste and abuse patterns and process bottlenecks in payer ecosystems.
• Oversee preparation of detailed business cases and outcome projections that quantify financial impact service quality gains and risk mitigation benefits associated with proposed payer transformation programs.
• Champion adoption of standardized methodologies templates and consulting frameworks within the payer practice to improve delivery consistency knowledge reuse and continuous improvement across engagements.
• Enable clients to navigate evolving healthcare regulations and policy changes by integrating compliance considerations into solution designs across benefits configuration network adequacy evaluation and member communications.
• Coordinate hybrid working routines and collaboration rituals to ensure consulting teams maintain high productivity timely stakeholder communication and effective documentation while balancing onsite and remote activities.
• Support talent development within consulting teams by mentoring on payer subject matter structured problem solving storytelling with data and stakeholder management to expand internal capability and client confidence.
• Align consulting deliverables with the organizations purpose of advancing access to quality care and financial sustainability demonstrating how each engagement contributes to broader societal health outcomes.
• Maintain strong focus on operational feasibility and change adoption by working with client operations managers to design pragmatic implementation plans training approaches and performance monitoring dashboards.

Qualifications

• Demonstrate deep payer domain expertise with significant experience across health plan functions such as claims administration provider networks benefits design and utilization management in complex environments.
• Bring twelve to fifteen years of progressive consulting or strategy experience with substantial time spent leading payer oriented projects that require working with senior client stakeholders and cross functional teams.
• Possess strong analytical and problem solving capabilities using structured approaches and health data insights to diagnose root causes and develop practical recommendations that address payer business challenges.
• Exhibit advanced communication skills for creating clear presentations concise reports and engaging narratives that explain complex payer concepts in accessible terms for diverse audiences.
• Apply familiarity with common payer platforms workflow tools and reporting solutions to assess current technology usage and collaborate with technical teams on modernization initiatives when required.
• Utilize knowledge of healthcare regulatory frameworks and compliance expectations affecting payers to ensure that engagement designs minimize risk and remain aligned with industry standards.