Corp Managed Services - Associate RCMS- Eligibility Specialist - Operate

At PwC, our people in operations consulting specialise in providing consulting services on optimising operational efficiency and effectiveness. These individuals analyse client needs, develop operational strategies, and offer guidance and support to help clients streamline processes, improve productivity, and drive business performance. In operations and solutions at PwC, you will focus on providing consulting services to optimise overall operational performance and develop innovative solutions. You will work closely with clients to analyse operational processes, identify areas for improvement, and develop strategies to enhance productivity, quality, and efficiency. Working in this area, you will provide guidance on implementing technology solutions, process automation, and operational excellence frameworks.

Focused on relationships, you are building meaningful client connections, and learning how to manage and inspire others. Navigating increasingly complex situations, you are growing your personal brand, deepening technical expertise and awareness of your strengths. You are expected to anticipate the needs of your teams and clients, and to deliver quality. Embracing increased ambiguity, you are comfortable when the path forward isn’t clear, you ask questions, and you use these moments as opportunities to grow.

Skills

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

• Respond effectively to the diverse perspectives, needs, and feelings of others.
• Use a broad range of tools, methodologies and techniques to generate new ideas and solve problems.
• Use critical thinking to break down complex concepts.
• Understand the broader objectives of your project or role and how your work fits into the overall strategy.
• Develop a deeper understanding of the business context and how it is changing.
• Use reflection to develop self awareness, enhance strengths and address development areas.
• Interpret data to inform insights and recommendations.
• Uphold and reinforce professional and technical standards (e.g. refer to specific PwC tax and audit guidance), the Firms code of conduct, and independence requirements.
  
  

• Verify patient insurance eligibility and benefits prior to scheduled visits or procedures.
• Confirm coverage for exams, diagnostic tests (OCT, visual fields, etc.), and surgical procedures.
• Document copays, deductibles, coinsurance, and authorization requirements.
• Communicate insurance details to patients and front office staff.
• Work with insurance carriers to resolve eligibility issues.
• Maintain up-to-date records for compliance and billing accuracy.
  
  

• 2 and above years of experience in medical eligibility verification.
• Familiarity with payer requirements.
• Strong communication and customer service skills.
• Ability to manage multiple verification requests in a timely manner.
• Flexible working in Shifts