This position reports to Director Accounting and Financial Reporting and will be responsible for the timely and accurate reconciliation and filings of all regulatory and required accounting statements. The role is highly visible due to the financial interaction with the CFO and Business Leaders. This individual will ensure financial and administrative controls are in place for all accounting...

Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and/or the member’s authorized...

Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and/or the member’s authorized...

Under the Supervisor’s direction, the Member Appeals and Grievances Department Coordinator assists with all operational aspects of the Member Appeals and Member Grievances process for Commercial, TMP and Public Plans products. Responsibilities include, but are not limited to: distribution and classification of cases in compliance with applicable timeframes and regulations, gathering information on...

Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with the member and/or the member’s authorized...

The Application Systems Engineer Associate is primarily responsible for the administration and support of the infrastructure directly supporting Point32Health’s software services. This position enables Point32Health to meet its operational objectives by: Supporting production and non-production systems and responding to monitoring notifications and alerts to ensure maximum availability and...

The Associate Contract Specialist, under the direction of the Manager, Provider Network Management, is responsible for coordinating the contractual and operational implementation of network provider contracts in conjunction with internal departments, for hospitals, physician organizations, and medical groups. Coordinate maintenance of provider information changes.   The position requires a...

Under the direction of the Behavioral Health Manager, Provider Account Management (PAM), the Behavioral Health PAM will play a critical role in developing and maintaining key provider constituent relationships while serving as the primary point of contact for resolving escalated provider operational issues that may impact contract and/or overall Point32Health business strategy. The individual will...

The Billing, Cash, & Collections Associate is responsible for the premium receivable application process for all commercial product lines, as well as all monthly financial reconciliations, to ensure all premiums received have been properly applied in the account receivable system and are credited to the correct bank account based on product. Additionally, the Billing, Cash & Collections Associate...

This individual must be able to plan, organize, and prioritize work to ensure completion in a timely manner. He/she functions as a key contact and department representative of the Point32Health Senior Products Care Management Community values to both internal and external customers of the care management department through both verbal and written communications. Under the administrative direction...

Under the direction of the Senior Manager, Provider Communications, the Communications Specialist for Behavioral Health Communications is responsible for assisting in the planning, development, and distribution of behavioral health communications for a provider audience, including FAQs, newsletter articles, website copy, presentations, flyers/one-pagers, talking points, targeted provider outreach,...

Under the direction of the Senior Manager, Provider Communications, the Communications Specialist for Documentation is responsible for overseeing the development and updating of Provider documentation including Provider Manuals, policies, interactive forms, website content, user guides, and other materials. This role also assists the Web Production Coordinator in intaking requests for Provider...

As a participant on the HealthRules Payor (HRP) Configuration Team, the Configuration Analyst will work collectively to achieve the successful implementation and on-going maintenance of HRP (the core claims administration platform). The Configuration Analyst will play a key role in analyzing requirements, building configuration components in HRP, and supporting testing of the system. KEY...

This position is a key role in the Corporate Data and Analytics organization, responsible for the use of analytic tools and processes to unlock the value of data to help improve the wellbeing of our diverse members. The position will work in a nimble and supportive environment to use clinical data, member demographics, Social Determinants of Health and other unique datasets to support the...

A key role in the Corporate Data and Analytics organization, the Data Analyst will use analytic tools and processes to unlock the value of data and deliver insight on business performance. These insights will support business critical decisions and ultimately enterprise strategic business objectives.   Key Responsibilities/Duties – what you will be doing Demonstrate strong business problem...

As a Release Train Engineer (RTE), you will lead a highly collaborative, cross-functional Agile Release Train (ART) within Point32Health. You will advise and lead the ART teams on SAFe 4.5 values, principles and Framework to ensure that the ART is fully functional, productive, and focused on the delivery of the Program Increment (PI) Objectives. As the RTE, you will work with the ART Product...

The ASE DevOps Engineer is a multi-functional role primarily responsible for supporting and implementing build and deployment processes for all IS applications and environments. The role is heavily involved in developing and maintaining the automated build and deployment processes as well as supporting the development teams with the organization and management of their SDLC.   KEY RESPONSIBILITI...

The Enterprise Technical Architect is responsible for providing leadership and direction in understanding, advocating and advancing the enterprise architecture plan. This individual will support corporate-wide strategic initiatives that suggest possible use of technologies new to the company, which can deliver a positive return to the business. The individual in this position anticipates IT...

Under the supervision of the Facilities Operation Supervisor, the Facilities Technician Senior (Generalist) will lead or assist with all appropriate support tasks related to facility operations, with emphasis on building maintenance and internal office relocations. Schedules and leads daily internal staff and outside vendors in the planning and implementation of various construction, repair,...

Serving as the Sr. Data Compliance Analyst, the incumbent is responsible for assessment of all external disclosures for compliance with HPHC privacy, security and corporate proprietary data release policies. With limited supervision, evaluates requests for external disclosures and maintains detailed documentation related to the data handling and agreements requirements for such disclosures. The...

The IMO Coordinator provides essential functions in support of the Department’s mission to ensure the effective execution of projects at Tufts Health Plan. This includes activities required to promote and implement project standard methods, tools, training and reporting. As a member of the IMO team, the IMO Coordinator will collaborate within and outside the department to deliver essential project...

Instructional design specialist works with a Senior Instructional Designer(s) and Trainer(s) to complete needs assessments, identify training goals, and develop learning objectives. Reviews and updates are existing training programs using content provided by subject matter experts (SME). Performs analysis and data gathering with SMEs as needed. Designs and develops program instructor-led and...

The primary objective of this role is to oversee all IT technical project activities across architects, technical analysts, developers, application administrators, and all other technical team members for the IT Portfolio organizations to ensure the successful completion of all technical aspects of projects that ensure Point32Health’s business applications function successfully and enabling the...

The Lead Corporate Project Manager is responsible, on behalf of the Executive Sponsor or Business Sponsor, for the successful delivery of new capabilities via the successful management and delivery of cross functional, large scale, and complex projects intended to either reduce organizational risk or maximize strategic opportunities. This position works under the direction of the Director,...

The Lead Corporate Project Manager is responsible, on behalf of the Executive Sponsor or Business Sponsor, for the successful delivery of new capabilities via the successful management and delivery of cross functional, large scale, and complex programs intended to either reduce organizational risk or maximize strategic opportunities. These programs are frequently multi-year, with the highest...

The Lead Financial Planning Analyst serves as the key financial support person to a subset of all enterprise functional areas. Total administrative cost for these areas is $600M + and includes Operations, Information Technology, HealthCare Services, Corporate Data Analytics, and the Chief Medical Office. The position will report to the Manager of Financial Planning & Analysis and provide business...

The Manager, EDW Analytic Support seeks to maximize the value of Harvard Pilgrim’s information assets, with an emphasis on the value of the Enterprise Data Warehouse. The Manager supervises a team of highly skilled business and data analysts, and collectively they help constituents better understand the information that supports their business activities, recommend analytic approaches to address...

Under the general direction of the Operations Quality Assurance Manager and Supervisor, the Lead Quality Assurance Specialist listens to, and scores calls based on Point32Health policies, procedures, workflows and the Call Standards and Expectation Definitions document. The Lead Operations Quality Assurance Specialist will be responsible for assisting the supervisor with running reports for all...

Works collaboratively with vendors to develop effective and strategic partnership on execution of production operations. This role will have oversight of core functions as outlined by established contracts and will be responsible for ensuring that delivery is aligned to Point32Health enterprise strategy and executed according to associated Service Level Agreements. Partner with functional owners...

Responsible for overseeing the Integration of the technology portfolio operations processes required to deliver mission critical enterprise technology programs. Through effective and successful management of technology teams, the Program Director will ensure the highest level of standards and results are delivered for program and project management. The Program Operations Director will guide cross...

Responsible for leading category / vendor management processes and optimization initiatives to support enterprise wide Indirect Categories at Tufts Health Plan (including IT, Professional Services, Marketing etc.). The ideal candidate will possess: 5-7 years of experience leading strategic sourcing and vendor management activities Knowledge and expertise within indirect categories, Strateg...

Responsible for leading category / vendor management processes and optimization initiatives to support enterprise wide Indirect Categories at Point32Health. The ideal candidate will possess: 5-7 years of experience leading strategic sourcing and vendor management activities in the IT space Knowledge and expertise within IT indirect category Strategic, analytical, and interpersonal skills to...

As a Product Owner II at Point32Health, you will work in a fast-paced environment and will be responsible for defining key components of the assigned product utilizing deep industry expertise and knowledge of the assigned area of Robotics Process Automation (RPA) and the end customer. The Product Owner II will be responsible for providing the assigned product vision and roadmap that enables the...

The Product Planning Specialist will support all aspects of developing, managing and evaluating the Medicare Advantage product portfolio.  This will include existing Medicare Advantage Products performance, product development and market assessment and implementation of products in expansion markets.  Specific responsibilities include assisting with the analysis and reporting of the Medicare...

Under direction of management, the Program Manager III manages programs and projects with significant complexity, risk and/or cost.  Initial key responsibilities will include medium to large scale projects and initiatives. Responsibilities include successful implementation of large cross-functional projects to support the program(s), working closely with the appropriate Point32Health staff to...

The Provider Audit Analyst audits claims for coding accuracy, benefit, payment and contract interpretation in accordance to claims processing guidelines, HPHC Medical and Payment Policies and established audit protocol. He/she handles complex issues requiring extensive knowledge of claim systems, claims analysis, policies, quality assurance and appeals review process to accurately assess current...

The Provider Audit Analyst audits claims for coding accuracy, benefit, payment and contract interpretation in accordance to claims processing guidelines, HPHC Medical and Payment Policies and established audit protocol. He/she handles complex issues requiring extensive knowledge of claim systems, claims analysis, policies, quality assurance and appeals review process to accurately assess current...

Under direction of the Provider Enrollment Supervisor, the Provider Enrollment Specialist processes, maintains, and revises all components of the provider information database for all Point32Health products/plans. The candidate is responsible for the integrity of all practitioner information housed in the company’s provider data systems and communicates with both internal and external customers by...

Under direction of the Supervisor, Provider Operations, the Provider Operations Specialist is responsible for a broad range of NCPM activities for Provider Information, Provider Credentialing, Allied Health and NCPM as required. The Provider Operations Specialist reviews and assists in the development of processes for both new initiatives as well as reviewing existing processes. The Provider...

Under the direction of the Manager, Provider Account Management (PAM), the PAM 2 will play a critical role in developing and maintaining key provider constituent relationships while serving as the primary point of contact for resolving escalated provider operational issues that may impact contract and/or overall Point32Health business strategy. The individual will act as a senior liaison promoting...

As a Release Train Engineer (RTE), you will lead a highly collaborative, cross-functional Agile Release Train (ART) within Point32Health. This particular release train is one of high complexity within the Operations and IT systems implementation. You will advise and lead the ART teams on Scaled Agile Framework (SAFe) values, principles and framework to ensure that the ART is fully functional,...

Under the general supervision of the Supervisor, Membership Accounting, the responsibilities for this position will primarily be the development and refinement of the analysis and reconciliation for MSP, LIS, ESRD, Hospice and SCO to ensure compliance with all CMS and State regulations on internal department processes while supporting the product offerings. This individual will demonstrate the...

The position will report to the IT Audit Senior Manager and support the efficient and timely execution of multiple IT Audit Plan activities over a complex IT environment. The position will also be responsible to support the IT Audit team with various internal audit department strategic initiatives in an advisory capacity to meet Point32Health’s business objectives. Job Description Perform...

Working within the framework of established operating procedures, this position is accountable for the administration of client accounts and system data security. This position is also responsible for the creation and maintenance of administrative documentation and the training of new Security Administration staff. Reporting to the Director, CPMO the Senior Business Analyst provides data and...

Under the direction of the Senior Manager, Provider Communications, the Senior Communications Specialist for Behavioral Health Communications is responsible for assisting in developing strategy for behavioral health communications to providers and in the planning, development, and distribution of these communications, including FAQs, newsletter articles, website copy, presentations, flyers/one...

Point32Health is currently seeking highly motivated individuals to join their Corporate Data and Analytics department in the role of Senior Data Analyst. A key role in the Corporate Data and Analytics department, the Senior Data Analyst will use advanced analytic tools and processes to unlock the value of data and deliver insight on business performance. Strong relationship building skills,...

Under the direction of the Supervisor, Accounts Payable (AP), Sr. Finance Operations Analyst is responsible for ensuring the execution of multiple operational processes associated with the timely and accurate completion of AP processes. The Senior Business Analyst is responsible for multiple, complex, and time sensitive operational and technical processes across multiple systems. The Sr. Analyst...

Point32Health is currently seeking highly motivated individuals to join their Provider Analytics team in the role of Senior Data Analyst. A key role under the Analytics and Insights department, the Senior Data Analyst will use advanced analytic tools and processes to unlock the value of data and deliver insight on business performance. Strong relationship building skills, combined with a strategic...

Point32Health is seeking a dynamic and passionate Senior Manager of Sustainability who will be responsible for leading the vision, direction and implementation of sustainability and safety strategy. This role combines elements of strategy development, communications, operations (KPI/process implementation), advocacy, and project management to achieve goals. This role requires significant cross...

Point32Health is currently seeking a highly motivated individual to join our organization as a Sr. Provider Audit Analyst. Our audit analysts are responsible for review of claims for accuracy of coding, benefit, payment and contract interpretation in accordance to claims processing guidelines, Company Medical and Payment Policies and established audit protocols. He/she compiles and analyzes data...

The Sr 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 – what you will be doing: Perform business and data analytic functions in support of Pharmacy data exchanges and Accumulators,...

Point32Health is currently seeking highly motivated individuals to join the Provider Reimbursement Analytics team in the role of Senior Data Analyst.Under the direction of the Manager of Provider Analytics, the Senior Data Analyst is responsible for providing analytic solutions that deliver insight on provider financial performance. This role will serve as a key resource to generate and analyze...

Under the direction of the Senior Manager, Business Implementation and Analytics this position is responsible for supervising the analytical and data support for complex Finance Operations systems and processes including claims disbursements, provider negative balance, accounts payable and commissions. This individual will demonstrate understanding of business operations to provide effective...

Are you interested in becoming part of a dynamic team that is looking to innovate and improve? At Point32Health, we’re working to reshape the world of health care by pushing past the status quo and delivering even more to the diverse communities we serve: more innovation, more access, more support, and healthier lives. And we want people like you on our side to make it even better. Our legacy...