Point32Health
Remote Jobs
Point32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
35 Jobs
Senior Business System Analyst
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Title: Sr Business System Analyst Location: Remote Worker Home Office (MA) Full time Job Description: Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health. Job Summary The Sr. BSA will lead the analysis of business processes, identify system requirements, and drive the implementation of technology solutions that align with strategic business objectives. This role requires strong leadership, analytical skills, and the ability to collaborate effectively across departments and senior management. Job Description Key Responsibilities/Duties – what you will be doing (top five): - Lead requirements gathering sessions with stakeholders to understand business objectives and translate them into system requirements. - Analyze and document complex business processes and workflows, identifying areas for improvement and automation. - Define and prioritize system enhancements and new features based on business needs and strategic goals. - Collaborate with IT teams to design and develop solutions that meet business requirements, ensuring alignment with technical architecture and standards. - Conduct feasibility studies, cost/benefit analyses, and risk assessments for proposed solutions. - Manage the full lifecycle of projects from requirements gathering through to implementation and post-deployment support. - Mentor and provide guidance to junior business systems analysts, fostering a collaborative and knowledge-sharing environment. - Ensure compliance with regulatory requirements and best practices in systems development and implementation. - Serve as a subject matter expert on business processes and systems, providing insights and recommendations to senior management. - Other duties as assigned Qualifications – what you need to perform the job Certification and Licensure - Education - Required (minimum): Bachelor’s degree in business administration, Information Technology, Computer Science, or related field. - Preferred: Master’s degree Experience - Required (minimum): 5-7 years of professional experience - Preferred: 5-7 years of experience as a Business Systems Analyst, with at least 2 years in a senior or lead role. Skill Requirements - Proven track record of successfully leading complex projects and driving technology solutions within an organization. - Strong analytical and problem-solving skills with the ability to analyze data, identify trends, and make recommendations. - Excellent communication and interpersonal skills, with the ability to influence stakeholders and build consensus. - In-depth knowledge of software development lifecycle (SDLC), Agile methodologies, and project management practices. - Experience with business process modeling tools and techniques. - Technical proficiency in systems analysis, database management, and enterprise software applications. - Certification in Business Analysis (e.g., CBAP) or Project Management (e.g., PMP) is highly desirable. Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel): - Must be able to work under normal office conditions and work from home as required. - Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. - May be required to work additional hours beyond standard work schedule. Disclaimer The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time. Salary Range $105,080.72 -$157,621.08 Compensation & Total Rewards Overview The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes: - Medical, dental and vision coverage - Retirement plans - Paid time off - Employer-paid life and disability insurance with additional buy-up coverage options - Tuition program - Well-being benefits - Full suite of benefits to support career development, individual & family health, and financial health For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/ We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact.
Investigator II
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Title: Investigator II Location: Canton, MA time type Full time job requisition id R9186 Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health. Job Summary The Investigator II is an essential team member of the Special Investigation Unit (SIU) responsible for leading complex provider investigations related to fraud, waste, and abuse, and developing action plans to address the investigative findings and prevent future loss. The Investigator works closely with other members of the SIU to set investigative priorities, develop effective investigative strategies and techniques, and recommend measures to address new and evolving schemes. Job Description Key Responsibilities/Duties – what you will be doing (top five): - Lead moderately complex to complex investigations in established and emerging areas of Fraud Waste and Abuse (FWA) involving internal and external research, detailed data analyses, review of medical records, and interviews of members, providers, and other third parties. - Apply laws, regulations, plan policies and guidelines, contract provisions, coding rules, coverage rules, and industry standards to information gathered during the investigation. - Complete detailed reports of investigative activity and prepare summary findings notices for providers or other entities. - Work with SIU management to educate providers, recover overpayments, take action to prevent future loss, and monitor provider activity post-investigation. - Identify root causes of fraud, waste and abuse and recommending internal and external corrective actions to address these root causes. - Develop new investigations based upon case findings. - Recommend investigative priorities, strategies, and techniques. - Work with the analytics and intake team to develop and refine data mining to address new and evolving schemes. - Share expertise and promote investigative best practices among SIU management and staff. - Educate and collaborate with various business units to raise awareness of potential FWA concerns. - Perform out-of-the-box thinking, collaborate with others, and make a difference every day! - Other duties and projects as assigned. Qualifications – what you need to perform the job Certification and Licensure - Certified Professional Coder (“CPC”); Certified Fraud Examiner (“CFE”) designation a plus. Education - Required (minimum): Bachelor’s degree - Preferred: Degree preferably in a clinical or scientific field, business, accounting, computer science, or criminal justice. Experience - Required (minimum): 3-5 years’ related experience in health insurance and/or fraud investigations. Preferred: Experience in audits/investigations including experience drafting and distributing summary findings notices to providers or other entities. Skill Requirements - Ability to produce clear, concise, and well-organized documents. - Resilient, collaborative, flexible, innovative. Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel): - Must be able to work under normal office conditions and work from home as required. - May be required to attend meetings at other company locations or other external meetings. - Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. - May be required to work additional hours beyond standard work schedule. Disclaimer The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time. Salary Range $80,741.22 -$121,111.82 Compensation & Total Rewards Overview The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes: - Medical, dental and vision coverage - Retirement plans - Paid time off - Employer-paid life and disability insurance with additional buy-up coverage options - Tuition program - Well-being benefits - Full suite of benefits to support career development, individual & family health, and financial health We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment.
Member Services Advocate
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Role Description Under the general direction of the Service Center Supervisor, the Member Services Advocate provides exceptional customer service, navigating the complexities of the healthcare system, addressing inquiries, resolving issues and ensuring members have a positive experience with Point32Health. - Handle inbound calls from members with professionalism and attentiveness, addressing inquiries related to health insurance benefits, coverage, claims, and eligibility. - Support and advocate for members to ensure that they receive the care/support needed. - Provide education and guidance to members about their Point32Health benefits and take ownership of each call to ensure that issues are resolved promptly and accurately. - Assist members in understanding and accessing their benefits and educate members on how to use self-service tools, delivering proactive/anticipatory service. - Record call details and member interactions in the system accurately, ensuring that all relevant information is documented for future reference and reporting, ensuring HIPAA, State, and Federal regulations and confidentiality standards are met. - Work collaboratively with other team members and departments to address complex issues and ensure a seamless member experience. - As a brand ambassador for Point32Health, go above and beyond to ensure member satisfaction, proactively identifying and addressing needs and concerns. - Represent the voice of the customer by contributing to continuous improvement initiatives and providing feedback on member interactions and suggesting process enhancements. - Adhere to assigned schedules to ensure appropriate phone queue coverage & meet or exceed department established key performance indicators. - Execute outbound calls to improve the member experience and assist in member retention. - Ensure all interactions are HIPAA compliant and adhere to state and federal regulations. - Other duties as assigned. Qualifications - Required: Associate degree or equivalent work experience. - Preferred: Bachelor’s degree or equivalent work experience preferred. - Required: 0-2 years of relevant experience. - Preferred: Customer service experience in health care, call center, or corporate office. - Knowledge of medical terminology. - Prior experience training and working in a virtual/remote setting. Requirements - Demonstrated ability to provide exceptional service, including active listening, empathy, and clear communication with members. - Ability to put yourself in someone else’s shoes and demonstrate compassion. - Strong understanding of health insurance products, policies, and industry regulations, or the ability to quickly learn and apply new information. - Adept at identifying issues, analyzing information, and providing effective solutions in a timely manner. - Excellent verbal and written communication skills, with the ability to convey complex information clearly and professionally. - High level of accuracy in handling member information, processing requests, and documenting interactions. - Capable of managing multiple tasks simultaneously while maintaining focus and efficiency. - Comfortable using computer systems, CRM software, and other relevant technology to manage member interactions and data. - Ability to adjust to changing priorities and new processes in a dynamic work environment. - Strong people skills with the ability to work effectively with team members and contribute to a positive work atmosphere. - Skilled in managing and resolving conflicts and complaints with professionalism and patience. Benefits - Medical, dental, and vision coverage. - Retirement plans. - Paid time off. - Employer-paid life and disability insurance with additional buy-up coverage options. - Tuition program. - Well-being benefits. - Full suite of benefits to support career development, individual & family health, and financial health.
Senior Business Data Analyst
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Role Description The Senior Business Data Analyst will be responsible for completing complex business system and data analytic assignments in support of departmental objectives, functioning as a senior analytic and technical lead on a broad array of assignments. Duties/Responsibilities - Collaborates with internal business and external vendor constituents to conduct analytic assignments in support of requested business solution(s). - Creates a technology roadmap in support of a business strategy with business leadership across multiple departments. - Ensures that appropriate requirements, associated business rules and data standards, and technical specifications for requested solutions are documented. - Develops design recommendations commensurate of requested solution, ensuring recommendations comply with corporate architectural standards and federal and state regulations and/or mandates pertaining to the privacy and security of the company’s core data assets. - Facilitates review of design with governing committees. - Plans, develops, and implements solution designs of significant scope and complexity. - Solutions may include application or extract program code, production reports and analytic finding reports. Independently develops solutions of considerable scope and complexity. - Develops and trains IT and business personnel on test strategies, plans, and scripts and executes test procedures to ensure compliance of developed solution with documented specifications. Reports test results to project stakeholders. - Collaborates to maintain core reference domain content via master data management tools. Monitors core dataset quality thresholds to identify dataset content issues that require resolution. - Initiates and manages constituent-specific data remediation projects to resolve prioritized issues. - Monitors production processes of previously implemented information management solutions to proactively achieve error-free performance standards. - Performs analysis to establish root cause(s) of identified issues through implementation and documentation of necessary modifications. - Perform out-of-the-box thinking, collaborate with others, and make a difference every day! - Other duties and projects as assigned. Qualifications - Required (minimum): Bachelor’s degree in a related field - Preferred: Master’s degree - Required (minimum): 5-7 years of professional experience - Preferred: 5-7 years of experience, including a minimum of 3 years in health care data warehouse environment. - Experience with documenting requirements, use cases, test cases, success criteria - Experience in Master Data Management is preferred - Experience in database systems (Teradata, Oracle), as well as end-user analytic tools. - Superior analytic problem-solving skills, including business process and data analytics. - Data knowledge in finance or clinical side of insurance business; demonstrated ability to develop and deliver data analytic solutions of a complex nature. - Demonstrated ability to manage multiple projects simultaneously. - Strong skills of organization, and the ability to prioritize multiple concurrent tasks. - Strong verbal and written communication skills as well as negotiation skills. - Team player, committed to quality process and outcomes. - Advanced technical skills in SAS and SQL programming languages - Demonstrated understanding of principles of data modeling; Extract Transform Load (ETL) specifications - Ability to learn new technologies and applications quickly. - Resilient, collaborative, flexible, innovative. Working Conditions and Additional Requirements - Must be able to work under normal office conditions and work from home as required. - Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. - May be required to work additional hours beyond standard work schedule. Salary Range $107,203.91 - $160,805.87 Benefits - Medical, dental and vision coverage - Retirement plans - Paid time off - Employer-paid life and disability insurance with additional buy-up coverage options - Tuition program - Well-being benefits - Full suite of benefits to support career development, individual & family health, and financial health We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Scam Alert Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org.
Program Coordinator
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Role Description Under the direction of the Supervisor – Behavioral Health, the Program Coordinator – Behavioral Health is responsible for the daily management of non-clinical reviews supporting the clinical, business, and program-related work of the department. This role functions as a key member of the Program Coordinator Team and the BH Utilization Management department, representing Point32 Health values to both internal and external customers through written and verbal communication. Key Responsibilities/Duties - Program Planning and Development: - Develop program objectives and strategies in alignment with organizational goals. - Plan and schedule program timelines and milestones using appropriate tools. - Coordinate resources and staff to ensure successful program implementation. - Program Management: - Manage the day-to-day operational aspects of the program(s). - Monitor progress and make adjustments as needed to ensure goals are achieved. - Prepare and manage budgets, allocate resources, and track expenses. - Stakeholder Engagement: - Build and maintain relationships with stakeholders, including participants, partners, and vendors. - Communicate effectively with stakeholders to ensure program success and resolve issues. - Evaluation and Reporting: - Monitor and evaluate program effectiveness using qualitative and quantitative methods. - Prepare and present reports and metrics to stakeholders on program performance. - Compliance and Risk Management: - Ensure programs comply with relevant regulations, policies, and procedures. - Identify and mitigate risks that may impact program success or organizational reputation. - Administrative Support: - Provide administrative support, such as scheduling meetings, preparing materials, and managing correspondence. - Maintain accurate records and documentation for reporting and auditing purposes. - Other duties as assigned. Qualifications - Education: - Required: Bachelor’s degree - Preferred: Master’s degree - Experience: - Required: Minimum experience in relevant field - Preferred: Experience working in the non-profit sector or with government agencies. - Knowledge of specific industry regulations and standards relevant to the program. - Skill Requirements: - Proven experience in program management or coordination, preferably in a similar field or industry. - Strong organizational and time management skills with the ability to manage multiple projects simultaneously. - Excellent communication and interpersonal skills, with the ability to collaborate effectively with diverse stakeholders. - Proficiency in project management tools and software (e.g., Microsoft Project, Excel, or similar). Requirements - Must be able to work under normal office conditions and work from home as required. - Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. - May be required to work additional hours beyond standard work schedule. Benefits - Medical, dental, and vision coverage - Retirement plans - Paid time off - Employer-paid life and disability insurance with additional buy-up coverage options - Tuition program - Well-being benefits - Full suite of benefits to support career development, individual & family health, and financial health Disclaimer The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time. Salary Range $23.14 - $34.71 Compensation & Total Rewards Overview The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law. Scam Alert Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org .
Senior Community Outreach Representative
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Title: Sr Community Outreach Representative – Duals – Worcester County Location: Remote Worker Home Office (MA) Full time Job Description: Who We Are Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. Job Summary HYBRID OPPORTUNITY FOR LOCAL CANDIDATES The Sr Community Outreach Representative - Duals will be highly visible in the 65+ Community to promote Point32Health, Duals Plan (Point32Health Duals) and its benefits that lead to the enrollment of new members. Education will be given to prospects and their care givers, Community Health Centers, Providers, local Elder Services, Councils on Aging, Housing Authorities, Senior Centers, and SHINE Counselors. The primary objective of this position is to identify prospective Duals-eligible members, explain the features and benefits of the plan in an assigned territory/marketplace, and assist with enrollment into the plan. Successful candidates generate leads from a variety of sources including networking, account management, grassroots sources as well as from member referrals. Job Description Key Responsibilities/Duties – what you will be doing (top five): • Effectively present the Point32Health Duals Program and its benefits to the 65+ MassHealth populations residing in the Community. • Meet or exceed enrollment goals within an assigned territory; using a full sales mix of outreach & sales activities Conduct group and/or individual sales presentations and enroll eligible prospects on site as often as possible • Primary activities include community-based lead generation, developing partnership-based relationships with providers, community-based-organizations, senior housing, senior centers, advocacy agencies, etc. Other outreach & sales activities include conducting sales meetings, in-houses, conversion meetings, lead meetings, special events, developing referrals and having regular business reviews with accounts. • Perform lead follow up and qualification calls to interested individuals to explain the purpose and benefits of Point32Health Duals and scheduling home visits to meet with prospects. • Maintain lead tracking and sales database for all sales activity and consumer interactions performed. • Submit completed enrollment applications on a timely basis. • Coordinate and develop relationships with key community groups to allow Point32Health Duals to participate in community-sponsored events. • Represent Point32Health Duals at community/company-sponsored events to promote the company and the plan, raise awareness, network, and generate leads. • Provide weekly activity plans, result summaries and monthly expense reports. • Know provider networks (physician, hospital, and pharmacy) within assigned territories. • Maintain good working knowledge of competitor products in the market • Represent Point32Health Duals in a manner consistent with stated company values and departmental Code of Ethics • Adhere to company and departmental policies and procedures, including abiding to all CMS and EOHHS guidelines. • 100% compliance with completion of all required certifications, licensing, continued education, policy acknowledgement and work plan documents within dates of completion requirements. • Submit completed enrollment applications on a timely basis • Successfully complete annual product training, AHIP certification and additional training and/or certification that may be required • Perform other duties as necessary and assigned • Other duties and projects assigned. Salary Range $70,494.69 -$105,742.03 Commissions Range $36,000.00 -$36,000.00 Compensation & Total Rewards Overview The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law. Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes: - Medical, dental and vision coverage - Retirement plans - Paid time off - Employer-paid life and disability insurance with additional buy-up coverage options - Tuition program - Well-being benefits - Full suite of benefits to support career development, individual & family health, and financial health We welcome all All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Director, Medicare Product Strategy
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Role Description The Director is responsible for the overall success of Point32Health’s Medicare offerings, including the Medicare Advantage and Medicare Supplement product lines. In addition to managing existing products and markets, the Director will lead or play a key role in the evaluation of potential market expansion opportunities, and subsequent implementation. The Director is accountable for profit and loss results, membership growth and retention, medical and administrative expense targets, and regulatory/compliance requirements. - Lead a team that establishes, implements, and performance manages product strategies across a highly matrixed organization. - Coordinate with a broad set of stakeholders (e.g., providers, brokers, vendors). - Key elements of the product strategy include: - Product design - Margin targets - Membership targets (sales and retention) - Competitive positioning - Marketing strategy - Care management model - Provider network - Establish a management structure that monitors the performance of chosen strategies relative to established targets. - Work closely with a cross-section of functional teams (sales, operations, clinical services, population health, quality, network management, legal, compliance, finance, marketing, etc.) to establish shared accountability for performance objectives. - Coordinate a robust evaluation of market potential (growth/financial) for potential expansion markets. - Establish and maintain productive relationships with senior leaders of strategic partners, including providers, regulators, advocates, and vendors. Qualifications - Experience in managing Medicare products. - Strong leadership and team management skills. - Ability to analyze market data and develop strategic recommendations. - Excellent communication skills for internal and external stakeholders. Requirements - Develop multi-year market strategy. - Ensure the implementation of initiatives critical to strategic success. - Establish key performance objectives and monitor results. - Coordinate closely with enterprise leaders on shared objectives. - Develop recommendations to optimize ongoing product positioning. - Communicate product performance to internal stakeholders. - Evaluate potential near-term opportunities alongside potential strategic partners. - Develop and present strategic recommendations to senior leadership. - Develop cross-functional relationships to support strategy setting and execution. Benefits - Medical, dental and vision coverage - Retirement plans - Paid time off - Employer-paid life and disability insurance with additional buy-up coverage options - Tuition program - Well-being benefits - Full suite of benefits to support career development, individual & family health, and financial health Salary Range $176,540.80 - $264,811.20 Company Description Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone.
Instructional Design Specialist
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
• Leads or supports consultations with stakeholders and subject matter experts to define key objectives and design effective learning solutions • Tracks instructional design projects including timelines, deliverables, and stakeholder engagement • Creates engaging instructional materials, including both computer-based and instructor-led content • Refines materials based on stakeholder and user feedback, ensuring that learning content is effective, accurate, and user friendly • Reviews instructional materials for quality and alignment with learning outcomes • Fosters strong relationships with stakeholders and demonstrates organizational values
Disaster Recovery Lead
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
Role Description The Lead Information Security Analyst works closely with technology colleagues and business leadership to align both technical and strategic cyber & information security solutions with business needs. This position will support the design and continued maturity of cyber & information security processes and will interact regularly with business and technology stakeholders at Point32Health and external entities, as appropriate. The Disaster Recovery Lead role reports into and is part of the overall resilience program. This role has on-call responsibilities as part of the overall Incident Management & Crisis Management framework and is a critical partner for technology owners. - Evolves and maintains the DR framework, plans, and standards - Ensures alignment with Business Continuity (BC) and Incident/Crisis Management - Coordinates DR testing, exercises, and continuous improvement - Tracks remediation of DR gaps and test findings - Reports DR readiness and maturity to leadership - Coordinates recovery and incident response activities DUTIES/RESPONSIBILITIES – what you will be doing (top five): - Provides leadership in planning, designing, assessing, and/or implementing strategic security program improvements. - Provides advanced information security consultation for all aspects of information security, compliance, policy, risk management, and remediation. - Identifies process improvements and develops plans to meet or exceed security best practices. - Ensures the confidentiality, integrity, and availability of the information residing on or transmitted to/from/through the enterprise’s devices, servers, and other systems and data repositories. - Provides technical expertise and administration of security solutions, where applicable. - Participates in the design, implementation, and administration of security tools to reduce risk. - Identifies technology trends and evolving social behavior to support the success of the business. - Oversees and maintains system consistency through regular audits. - Provides leadership and education to colleagues; participates as an active member of the IT and security community at Point32Health to promote information sharing, respectful challenge, efficiency, control effectiveness, and program quality through continuous improvement. - Creates meaningful and detailed metrics based on security needs. - Other duties and projects as assigned. Qualifications - Required (minimum): Bachelor’s degree in a related field - Preferred: Master’s degree - Required (minimum): 5-7 years of related work experience. - Preferred: 5-7 years of experience in information security, with a focus on security analysis or similar roles, including at least 2-3 years in a leadership or supervisory position. - Broad knowledge of commonly used information security concepts, best practices, and standards. - Demonstrated expertise in at least two leading security areas, e.g., privileged access management, enterprise identity & access management, cloud architecture, data loss prevention, security information & event manager, incident management, third-party vendor risk assessment, API security, network security, malware prevention, database masking, secure development, application security testing, multi-factor authentication schemes. - Self-directed; expected to identify and lead efforts to correct security controls and/or process improvements. - Strong collaboration, facilitation, and negotiation skills. - Strong communication skills, both written and verbal. - Ability to explain complex technical issues to non-technical colleagues and business executives. - Ability to troubleshoot and independently solve problems as they arise. - Familiarity with HIPAA Security Rule and other regulatory requirements. - Proven analytical and problem-solving abilities. - Project and program management planning and organizational skills. - Customer service focused. - Time management and prioritization. Requirements - Must be able to work under normal office conditions and work from home as required. - Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. - May be required to work additional hours beyond standard work schedule. Benefits - Medical, dental and vision coverage - Retirement plans - Paid time off - Employer-paid life and disability insurance with additional buy-up coverage options - Tuition program - Well-being benefits - Full suite of benefits to support career development, individual & family health, and financial health
Outbound Sales Specialist
Point32HealthPoint32Health is a leading not-for-profit health organization formed by a merger between Harvard Pilgrim Health Care and Tufts Health Plan. With the mission of
• Make outbound calls to digital leads, and other internal campaigns. • Qualify prospects and direct them to resources or transfer to licensed agents. • Properly manage pipeline of leads by consistently making outreach attempts (Calls, emails). • Providing requested material and assisting prospects through the sales cycle. • Properly use the sales center tools: CRM (for data entry and lead management), soft phone, TTY software, etc. • Able to multi-task using multiple systems simultaneously. • Meet or exceed lead generation goals.
25more opportunities are still waiting for you.Log in now and take your next shot before someone else does.