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...

Educate and be highly visible in the 65+ Community in order to promote Tufts Health Plan, Senior Care Options Plan (THP SCO), and its benefits that lead to the enrollment of new members. Education will be given to prospects and their caregivers, Community Health Centers, Providers, local Elder Services, Councils on Aging, Housing Authorities, Senior Centers and SHINE Counselors. The primary...

Business Data Reporting Analyst participates as a member of the SMPO team focused on Senior Products data integration. This role will work to ensure that business technology solutions align with the long-term vision and goals of Point32Health, and with the existing enterprise architecture. This role leverages appropriate influence on collaborative efforts to ensure that the best knowledge is...

The Business Analyst reports directly to the Lead or Manager.The Business Analyst coordinates with other members of the department, IS and the Business to identify problems and needs of the organization, collect, analyze, and document business requirements, information system recommendations, and process improvement recommendations. This individual participates in planning and implementation of...

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 direction from the Credentialing Supervisor, the Credentialing Specialist is responsible for ensuring all THP affiliated physicians and other independent practitioners and allied providers are qualified to provide health care services to members in accordance with THP’s policies and procedures, state laws and/or regulatory requirements (e.g. NCQA). Practitioners are recredentialed at least...

Under the direction of the Documentation Manager the Documentation Specialist supports and participates with other members of the Documentation team in the development and documentation of clear and accurate content for use by staff in the Commercial HPHC Call Center and Claims department. Communicate regularly with staff and with partner departments to assess customer needs. Key Responsibilities...

Under the general direction of Call Center Supervisor, the customer relations senior representative is responsible for providing accurate and thorough interpretation of THP Medicare Preferred benefits, claims processes, eligibility, and enrollment policies to members, providers, prospective providers, employers, and internal customers. In addition to providing accurate technical information, the...

The Senior Auditor supports the Audit Plan Owner in the execution of the annual audit plan and is responsible for the efficient and timely delivery of assigned audit activities as well as department strategic initiatives. The Senior Auditor will report to the Audit Senior Manager and work in a hybrid environment.   Key Responsibilities/Duties – what you will be doing Perform audit activities...

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...

TRANSFORMING HEALTHCARE, ONE MEMBER AT A TIME Remote Position (must reside in CT, DC, FL, GA, IL, IN, IA, MA, ME, MD, MN, NC, NH, NJ, NY, OH, PA, RI, SC, TX, VT or WA.) Full Time $19.00/hr.($39,520 annually) + monthly incentives after training WHAT MAKES US STAND OUT… Here at Point32Health our member service representatives are the backbone of the company. Our members are taken care of...

TRANSFORMING HEALTHCARE, ONE MEMBER AT A TIME Remote Position (must reside in CT, DC, FL, GA, IL, IN, IA, MA, ME, MD, MN, NC, NH, NJ, NY, OH, PA, RI, SC, TX, VT or WA.) Full Time $19.00/hr. ($39,520 annually) + monthly incentives after training WHAT MAKES US STAND OUT… Here at Point32Health our member service representatives are the backbone of the company. Our members are taken care of...

TRANSFORMING HEALTHCARE, ONE MEMBER AT A TIME Remote Position (must reside in CT, DC, FL, GA, IL, IN, IA, MA, ME, MD, MN, NC, NH, NJ, NY, OH, PA, RI, SC, TX, VT or WA.) Full Time $19.00/hr. ($39,520 annually) + monthly incentives after training WHAT MAKES US STAND OUT… Here at Point32Health our member service representatives are the backbone of the company. Our members are taken care of...

Under the direction of the Clinical Pharmacist, Care Management, the Pharmacy Technician is responsible for supporting Care Management teams in all aspects of day- to -day functions. Additional responsibilities include responding to inquiries and appropriate follow up; supporting the team with projects, gathering data and information to report on member issues. Key Responsibilities/Duties – what...

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...

Provide analytical support for programs managed in the department, using word and excel programs and data base queries. Responsible for tracking work, processing and creating reports to support Department metrics and outcomes. Key Responsibilities/Duties – what you will be doing Assisting with data display options, report/dashboard layout techniques, and data organization Extracting and...

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,...

Under the direction of the Manager of Operations Programming Services, the senior project manager is responsible for planning, coordinating, tracking, and implementing projects related to the organization’s strategic goals, which are often cross-functional, large scale, and complex projects intended to either reduce organizational risk or maximize strategic opportunities. Supports and advocates...

The Senior Accountant position offers many challenges and opportunities in a fast-paced environment for a leading Health Care Organization. Primary responsibilities are leading the monthly financial closing process for multiple products, participate with the preparation of quarterly and annual statutory filings and preparation of schedules supporting internal and external reporting. Key Responsib...

Under general direction of the Supervisor of Member Appeals and Grievances, the primary function of the Sr. Analyst is to ensure the Appeals and Grievance team delivers timely, thorough and accurate case information to members, providers and other external constituents. This individual will provide technical support, direction and guidance to ensure staff deliver best in class service and...

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...

The Senior Business Consultant, utilizing business consulting & transformation methods and techniques, collaborates with other members of the department, IS and the Business to help improve results. The Senior Business Consultant is part of the Business Consulting & Transformation Services Department that provides services such as strategy development at the department level, process assessments,...

The Senior 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 $400M + and includes: Operations, Information Technology, HealthCare Services and all other non-business line administrative areas. The position will report to the Manager of Corporate Finance and provides business partner...

Managed team of senior level project managers and oversee implementation of corporate agenda projects. Key Responsibilities/Duties – what you will be doing Drive day-to-day project and program execution. Responsible for oversight of project delivery including: management of project scope, timeline, budget, risks, issues, interdependencies and resource tracking for both Agile and waterfall...

The Senior Developer works to establish the systems architecture and perform the design and development activities for scalable, high-performing, flexible, and reliable technical solutions using Software Development Life Cycle (SDLC) methodologies. These roles contribute to the success of Point32Health and position the Company to meet its strategic objectives by: Providing technical solutions...

The Sr. Technical Analyst provides business consulting and technical analysis for applications for the enterprise. This individual works with colleagues, business groups and technical teams to identify the ongoing needs of the enterprise for collaboration within the Application toolset, for example, Microsoft tools. The analyst facilitates the adoption of functionality and applications using...

The Software Asset Manager is responsible for the analyzing. Compliance, and tracking of software within the organization. The Software Asset Manager partners with key business leaders to track, manage, analyze, and evaluate software licenses using a software asset management system. Leads and provides support during software audits. Provides expertise and guidance around procedures and best...

The Marketing & Brand Sr Program Manager will report to the Chief Marketing & Brand Officer for Point32Health and be responsible for development, implementation and management of complex programs and initiatives including annual and ad hoc programs (e.g. enterprise marketing and planning as well as budget tracking), initiatives and projects associated with multiple business lines as well as at the...

The Senior Product Manager, Specialty is responsible for leading and managing a cross-functional team and vendor relationships to develop multiyear product strategies, roadmaps and competitive offerings to meet profitability and membership goals. Key Responsibilities/Duties – what you will be doing Develop and manage the 2-4-year product strategy for a set of product lines and/or geographic...

Under the general direction of Call Center Supervisor, is responsible for providing accurate and thorough interpretation of Harvard Pilgrim Stride of NH, claims processes, eligibility and enrollment policies to customers.In addition to providing accurate technical information, the Team Lead, Senior Products Member Services Call Center is responsible for resolution of complex customer inquiries...