Job Description

At PwC, our people in finance consulting specialise in providing consulting services related to financial management and strategy. These individuals analyse client needs, develop financial solutions, and offer guidance and support to help clients optimise their financial performance, improve decision-making, and achieve their financial goals. In financial operations at PwC, you will specialise in improving the efficiency and effectiveness of financial operations within organisations. Your work will involve assessing financial processes, identifying areas for improvement, and designing and implementing solutions to streamline financial operations, enhance controls, and reduce costs. You will be responsible for providing guidance on financial systems implementation, process automation, and financial shared services.

Driven by curiosity, you are a reliable, contributing member of a team. In our fast-paced environment, you are expected to adapt to working with a variety of clients and team members, each presenting varying challenges and scope. Every experience is an opportunity to learn and grow. You are expected to take ownership and consistently deliver quality work that drives value for our clients and success as a team. As you navigate through the Firm, you build a brand for yourself, opening doors to more opportunities.

Examples of the skills, knowledge, and experiences you need to lead and deliver value at this level include but are not limited to:

• Apply a learning mindset and take ownership for your own development.
• Appreciate diverse perspectives, needs, and feelings of others.
• Adopt habits to sustain high performance and develop your potential.
• Actively listen, ask questions to check understanding, and clearly express ideas.
• Seek, reflect, act on, and give feedback.
• Gather information from a range of sources to analyse facts and discern patterns.
• Commit to understanding how the business works and building commercial awareness.
• Learn and apply professional and technical standards (e.g. refer to specific PwC tax and audit guidance), uphold the Firm's code of conduct and independence requirements.

Degree Preferred

Bachelor in Business Administration

Preferred Fields of Study

Accounting,Business Administration/Management,Finance

Certification(s) Preferred

CPA

Preferred Knowledge/Skills

Demonstrates some abilities and/or a proven record of success with identifying and addressing client needs:

• Responds to client and/or team requests promptly and professionally; readily offering assistance;
• Contributes to a positive, collaborative working environment;
• Seeks instruction, feedback and coaching to improve performance proactively.
• Analyzes, evaluates and resolves member & provider appeals, disputes, grievances, and/or complaints from health plan members, providers and related outside agencies in accordance with the standards and requirements established by the Centers for Medicare and Medicaid and/or health plan.
• Prepares and organizes case research, notes, and documents.
• Contacts the member/provider through written and verbal communication;
• Requests, obtains and reviews medical records, notes, and/or detailed bills as appropriate;
• Applies contract language, benefits, and review of covered services;
• Conducts research, fact checking and analysis and recommends appropriate course of action and next steps for management review;
• Research claim / service authorization appeals and grievances using support systems to determine appeal and grievance outcomes inclusive of claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error;
• Determines appropriate language for letters and composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements;
• Communicates resolution to members (or authorized) representatives;
• Works with provider & member services to resolve balance bill issues and other member/provider complaints;
• Assures timeliness and appropriateness of responses per state, federal and health plan guidelines;
• Responsible for meeting production standards set by the department; and,
• Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested.

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