• Independently analyze and apply CGL, umbrella, and excess policy language. • Manage legacy runoff claims tied to policies issued primarily in the 1970s–mid‑1980s. • Handle complex asbestos bodily injury, talc, environmental contamination, PFAS, and other mass tort claims. • Manage litigated matters including coverage actions filed against Allstate.

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. Job Summary: Reporting to the Manager of Care Management Operations, the Operations Manager is responsible for documentation of care management processes and for providing operational oversight and analysis of our care management programs including compliance, program development, evaluation, and performance monitoring. This role assumes management of and accountability for the day-to-day non-clinical operations for these programs and is the subject matter expert for program operations. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions/Responsibilities: · In collaboration with the Regulatory Program Manager, responsible for analyzing the impact of accreditation and regulatory changes and makes recommendations on programmatic operational changes to ensure compliance. · Develops, maintains, stores and communicates non-clinical policies, standard operating procedures and job aids for the CM department in collaboration with subject matter experts and business owners. · Annually reviews and updates non-clinical policies, standard operating procedures and workflows for needed revisions to meet model of care (MOC) changes; to ensure continued regulatory and contractual compliance; and to reflect best practices of care management. · Manages non-clinical operations for Care Management teams, including implementation of effective metrics to monitor productivity and compliance. · Serves as operations subject matter expert and leads workflows/processes and initiatives related to care management programs in collaboration with other business areas including but not limited to IT, UM, AG, Clinical Informatics, Quality, Public Partnerships, Marketing, Product and Transformation teams. · Liaison between IT and clinical to make system configuration and reporting changes including submitting requests and planning/ overseeing user acceptance/ regression testing. · In collaboration with the clinical care management leadership team, represents the CM programs in complex cross-functional teams and projects as the subject matter expert (internally and externally) on care management related matters. · Facilitates meetings and decision making as well as identifies scalability opportunities. · Identifies, communicates, and escalates issues to leadership on a timely basis. · Independently problem solves programmatic issues and implements appropriate solutions. · Supports clinical with audits from documentation preparation through operationalizing corrective action plans. · Liaison between clinical and reporting teams for development of standard reports to monitor and report on overall department metrics and care management program evaluation. · Accountable for tracking KPI metrics for care management goals and outcome targets where applicable and implementing operational changes in partnership with managers of care management as they relate to department metrics and clinical program performance. Supervision Exercised: · N/A Supervision Received: · Weekly supervision with Manager of Care Management Operations Qualifications: Education: · Bachelor’s degree or equivalent combination of education and relevant experience in a health plan setting required. Education Preferred/Desirable: · Master’s degree in Health-Related/Public Health field preferred. · Previous experience in Care Management strongly preferred. Experience: · 5+ years of healthcare/managed care experience. · 5+ years project/ program management experience or other applicable work experience Certification or Conditions of Employment: · Pre-employment background check Competencies, Skills, and Attributes: · Exceptional written and oral communication skills. · Excellent organizational skills and attention to detail. · Ability to interact with all levels of the organization, as well as external stakeholders. · Superior meeting facilitation skills and experience in leading cross-functional teams · Demonstrated ability to work independently and manage multiple complex projects simultaneously. · Proactive, motivated, and a collaborative team player. · Demonstrated ability to adapt quickly to changing priorities. · Ability to analyze, compile, format, and present data to a variety of stakeholders. · Strong critical thinking, analytical, and problem-solving skills. · Proficiency with Teams and MS tools including Word, Excel, PowerPoint, Visio and MS Project · Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives. · Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project. · Able to negotiate enterprise solutions with other departments that work interdepartmentally. Working Conditions and Physical Effort: · Work is normally performed in a typical interior/office work environment. · Able to perform some work from a remote environment. · Fast-paced environment. · No or very limited physical effort is required. No or very limited exposure to physical risk · Regular and reliable attendance is an essential function of the position. Compensation Range $86,500- $125,500 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing. Note: This range is based on Boston-area data, and is subject to modification based on geographic location. About WellSense WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

Role Description IVX Health is seeking a Clinical Central Operations Manager (RN, LPN, or MA) to lead and optimize our Central Operations function. This hands-on leadership role focuses on enhancing performance, service quality, and seamless collaboration between clinical and administrative teams. The ideal candidate brings strong experience in healthcare operations, team leadership, and process optimization to centralize workflows, manage day-to-day staffing, and drive operational excellence. What You Will Do - Team Leadership and Development - Hire, train, and lead a distributed remote team of operational and clinical support staff. - Oversee scheduling, time-card approvals, and resource allocation to meet demand. - Foster a high-performance culture with ongoing feedback, coaching, and development. - Operational Management - Centralize workflows and implement standard work processes for consistent quality. - Track key performance metrics (utilization, response times, quality scores) and drive data-informed decisions. - Surface frontline insights, pilot process changes, and measure outcomes to support enterprise-wide optimization. - Process Improvement and Compliance - Conduct regular reviews to verify adherence to processes, data accuracy, and quality standards. - Maintain clear communication with clinical and operational leaders to align on priorities. - Ensure both internal and external customer service expectations are consistently met. Qualifications - A Bachelor’s degree in Business Management, Healthcare Management, or a related field (or equivalent experience). - 3+ years of experience in healthcare operations, centralized services, or business process management. - Clinical background as RN, LPN, or MA. - Licensure requirements vary by position level. For designated levels, a current, unrestricted Registered Nurse (RN), Licensed Practical Nurse (LPN), or Medical Assistant (MA) license in good standing is required. - Prior experience leading teams and managing day-to-day operational performance strongly preferred. - Proven ability to manage, motivate, and develop a distributed workforce. - Strong skills in tracking and interpreting key metrics to inform decisions. - Excellent interpersonal skills for cross-functional collaboration and team cohesion. - Comfort with process standardization and real-time decision-making. Requirements - Pay is based on factors such as market location, job-related knowledge, skills, and experience, and is benchmarked against similar organizations in our size and industry. - It is not typical for an individual to be hired at or near the top of the posted range, as compensation decisions depend on the facts and circumstances of each case. - In addition to cash pay, full-time regular employees are eligible for commissions/bonus, 401(k), health benefits, and other company-provided benefits; some of these benefits may also be available to part-time employees. Benefits - Comprehensive Healthcare – Medical, dental, and vision coverage, including prescription drug plans and telemedicine services. - Flexible Savings Options – Choose from Health Savings Accounts (HSA) and Health Reimbursement Arrangements (HRA) to manage healthcare costs. - Supplemental Protection – Accident, critical illness, and hospital indemnity plans to provide additional financial security. - Dependent Care FSA – Pre-tax savings for eligible childcare and dependent care expenses. - 401(k) Retirement Plan – Secure your future with a competitive company match. - Disability Coverage – Voluntary short-term and long-term disability plans to protect your income. - Fertility and Family Support – Resources and benefits designed to support fertility care and family planning. - Life and AD&D Insurance – Financial protection for you and your loved ones. - Counseling and Wellness Support – Free resources to support emotional, physical, and financial well-being. - Education Assistance – Tuition reimbursement and certification support to help you grow in your career. - Continuing Education – Access to a CEU library for ongoing professional development. - Charitable Giving and Volunteer Program – Matched donations and paid volunteer time off to support causes you care about. - Employee Referral Bonus – Earn rewards for helping us find top talent.

• Lead the strategic vision for the Development Operations Department • Oversee all aspects of grant management, including grant writing, proposal development, and grant reporting • Oversee and optimize all development operations, including processing donations, tracking data in Salesforce, and donor reporting • Lead and execute external funder communications strategies • Support fundraising solicitation and funder relationship management • Ensure every donor and prospect has an elevated stewardship experience • Provide leadership, coaching, and performance management to the Development Operations Department team • Collaborate cross-functionally with program and finance teams to ensure compliance • Provide regular updates to leadership on grant performance • Conduct quarterly audits of grant compliance and expenditures • Review and validate all grant-related data entries to maintain accuracy • Help shape the strategy, programs/activities, and culture for Accelerate Change