TRANSFORMING HEALTHCARE, ONE MEMBER AT A TIME Remote Position (must reside in MA, RI, NH, CT, ME) 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 everyday because of this. The value we place on our reps is at the highest...

The Senior Product Manager is responsible for leading and managing a cross-functional product team to develop multiyear product strategies, roadmaps and competitive offerings to meet profitability and membership goals. WHAT YOU WILL BE DOING Develops and manages the 2-4-year product strategy for a set of product lines and/or geographic regions. Lead product- specific, cross-functional teams...

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...

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...

The primary purpose of this job family is to do the fundamental system administration required to ensure that the application functions properly. By serving as the lead of the given application, overseeing ongoing application performance, and following through on periodic application enhancements to successful implementation, the position includes, but is not limited to, providing the foundation...

The Associate Contract Specialist is responsible for assisting and supporting in any provider recruiting efforts, coordinating the contractual and operational implementation and ongoing maintenance of Allied Health providers or vendors contracts for plan products, and reporting on progress for any company initiatives involving provider recruitment or network maintenance and support. This individua...

The Business Systems 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 and technical requirements, information system recommendation. This individual participates in all phases of the development lifecycle in support of the development team, which is comprised of Solution...

Under the direction of the Manager, Allied Health Contracting, the Contract Manager, Allied Health Contracting negotiates and manages contracts with ancillary service providers in their assigned geographic region and network vendors with particularly complex provider and/or reimbursement issues. Key activities include, acts as point person for any large-scale provider recruitments and prioritizes...

Under the direction of the Manager, Provider Network Management, the Contract Specialist combines in depth business knowledge, technical and analytic skills as well as financial skills to ensure all aspects of a contract are implemented and managed throughout the life of the contract. The Contract Specialist serves as THP's liaison with the provider community as it relates to the interpretation of...

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...

At Point32Health, we believe that businesses can be powerful platforms for social change. Disability Inclusion is fundamental to this belief. Our mission is to leverage people’s differences to create better outcomes and guide and empower healthier lives for ALL. DEI, accessibility, and health equity in the Point32Health ecosystem are top priorities. Position Summary: Reporting to the Chief...

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...

This position is responsible for the development, execution and ongoing coordination of integrated digital marketing campaigns and initiatives that support acquisition, retention and brand strategies for the Senior Products division. This includes, but is not limited to: email marketing, social media, paid digital advertising, SEO/SEM, marketing automation and website content, design and functiona...

Responsible for overall web eligibility and processing of temporary EDI files. This position reviews, analyzes, and coordinates data testing for enrollment and billings changes to TAHP master for inbound and outbound eligibility files for vendors and employer groups.  Additional duties include identifying system issues, writing business requirements, reviewing functional specifications, recommendi...

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,...

Point32Health is currently seeking highly motivated individuals to join our organization as an Fraud Analyst within our Special Investigations Unit (“SIU”). The Fraud Analyst is an essential team member of the SIU, responsible for analyzing claim trends, patterns and outliers, developing and refining queries to detect potentially fraudulent claim submissions and performing initial background...

The Senior Health Care Analyst is responsible for leading analytical support including data and business analytics to improve the business performance of the Public Plans division. The analyst works closely with the appropriate Company staff to accurately analyze and report division and industry trends through effective planning, analysis, and project support. The primary focus of the role is to...

The Technical Program Manager is responsible for the successful delivery of new capabilities via the coordinated management of multiple, complex, technology intensive, cross-functional projects, and in some cases for identification and implementation of cross functional process improvements that will have a demonstrable bottom line impact and maintain or enhance customer satisfaction.   DUTIES/R...

The HRIS Analyst will support HR system implementations, upgrades, testing and other technical projects for assigned Workday modules, benefits, payroll, absence, time tracking, and compensation. The role will partner with Lead HRIS Analyst to serve as a technical point-of-contact and assist HR subject matter experts, business leaders, and IT with ensuring data integrity, efficient use of the...

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.   Key Responsibilities/Duties Perform administration functions for file...

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 proposed recommendations and system changes. They act as...

The IS CSC Support Specialist provides IT support services, via call center phone queu, email, and Service Now, to members of the Point32Health workforce (end-users) on a daily basis. The IS CSC Specialist must be able to effectively adhere to ITIL Incident Management standards, exceed customer service level agreements (SLAs) through proper data collection and analysis of incidents and requests,...

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...

Key Responsibilities/Duties Collaborate with stakeholders and the Business Configuration Team to establish the monitoring criteria and timeframe to execute claim monitoring tied to specific configuration change requests Manage a team of analysts to effectively execute testing using data analytics and/or running test scenarios related to system configuration Lead the continuous analysis and...

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 direction of the Director of Facility Engineering & Operations, the Manager of Mechanical and Electrical Operations leads a team of licensed technicians who are responsible for 24 x 7 x 365 operations at Point32health’s facilities and for preventative maintenance, repairs, construction, and the efficient operation of the company’s physical plant. The Manager’s areas of responsibility also...

TRANSFORMING HEALTHCARE, ONE MEMBER AT A TIME Remote Position (must reside in MA, RI, NH, CT, ME) 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 everyday because of this. The value we place on our reps is at the highest...

Under the supervision of the Point32Health Medicare Premium Billing Manager, this individual will serve as Team Lead for the Premium Billing team.  S/he is responsible for Macess distribution and tracking.  The Team Lead will also monitor quality controls and team members’ progress to advise Manager of areas of opportunity or improvement.  The Team Lead will also support the Manager by running...

The Procurement Contract Specialist drives contracting activities to ensure successful selection and implementation of vendor solutions, including contract negotiations.   Experience across various sourcing categories and/or the ability to rapidly learn and retain knowledge about the sourcing and contracting process and categories.   Strong project management, analytical, and interpersonal skills...

The Senior Procurement Center of Excellence Manager will lead vendor/vendor management strategic activities particularly focused on contract performance measures, quality activities, and risk management. The role provides core expertise in the four process domains (i.e., Performance Management, Financial Management, Relationship Management, and Risk Management) in support of sourcing and contract...

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...

Under the direction of the Manager, Provider Network Management, the Contract Specialist combines in depth business knowledge, technical and analytic skills as well as financial skills to ensure all aspects of a contract are implemented and managed throughout the life of the contract. The Contract Specialist serves as THP's liaison with the provider community as it relates to the interpretation of...

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) II, you will lead a highly collaborative, cross-functional Agile Release Train (ART) within Tufts Health Plan.   This particular release train is one of medium to 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...

The position will report to the Audit Senior Manager and provides support for the audit activities assigned.  The Senior Auditor will be responsible to evaluate the design and effectiveness of internal controls, utilize critical thinking to assess the impact of control deficiencies, perform testing for control operating effectiveness, and follow up on open issues. Job Description Perform audit...

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...

Responsible for the analytical and data support for complex Client Funding and Finance Operations processes and systems utilizing strong analytical skills, interpersonal skills, independent judgement and technical expertise. Responsible for utilizing THP data systems to develop new code to maximize system reporting capabilities, and develop reports. Under the direction of the Manager of Business...

Reporting to the Director, CPMO Operations the Sr. Business Analyst, CPMO Operations supports the CPMO through leading and supporting portfolio financial invoice management and budget deliverables, department metrics & reporting, internal project audits and standard, and ongoing process improvement work. This individual will play a key role in ensuring day-to-day operations run smoothly and the...

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,...

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,...

The Senior Program Manager will be responsible for collaborating with key leadership, cross-functional teams and key partners, clients, and/or alliances to define and execute strategic business programs and initiatives. The Senior Program Manager must be able to conceptualize and envision the impact of change and propose new ways to do business on behalf of the Point32Health organization. The...

The core business model of Tufts Health Public Plan’s products features multiple strategic provider partnerships including partnership with provider accountable care organizations (MassHealth ACOs). The senior analyst of accountable care strategy and business performance assumes ownership in the planning, development, management and continuous improvement of provider performance, with the goal of...

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: Collaborates with internal business and external vendor constituents to conduct analytic assignments in support of requested...

The position reports to the Compliance Program, Audit Senior Manager and provides support for the audit activities assigned. The position also supports the Compliance Program, Audit Senior Manager in his/her leadership of the functional area of business they audit and is responsible for the efficient and timely delivery of all Compliance audit activities, as listed in the Annual Audit Plan and any...

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 proposed recommendations and system changes. They act as...

Are you interested in becoming part of a dynamic team that is looking to innovate and improve?  Would you like to work for a company that has been rated by the BBJ (15+yrs) as one of the best places to work? Do you want to be part of a company that is committed to giving back to the community? Point32Health/ Harvard Pilgrim Health Care is currently seeking highly motivated individuals to join...

Under the general direction of Call Center Supervisor, is responsible for providing accurate and thorough interpretation of Tufts Health Plan (THP) benefits, claims processes, eligibility and enrollment policies to customers.  In addition to providing accurate technical information, the Provider Specialist Senior is responsible for resolution of complex customer inquiries, the facilitation of...

Under the general direction of TMP Customer Relations Manager the CR Member Supervisor supervises, mentors, and evaluates the member queue staff.  This person selects, orients, and develops representatives and team leads, coordinates appropriate staffing with operations, and resolves problems in accordance with policies and accepted practice. In addition to insuring accurate technical information,...

Working within the framework of established operating procedures, the Systems Engineer Associate provides technical support of the enterprise server systems.  Activities will include installation, operation, troubleshooting, maintenance, and optimization of server operating systems, server hardware, and storage.  The Systems Engineer Associate will work in a highly collaborative environment to...

Provide technical and break/fix support for all PC desktop hardware and software; peripherals such as printers, and mobile devices; Respond to incoming helpdesk incidents: diagnose and troubleshoot problems; coordinate desktop computer and software installations, and provide end-user training on desktop hardware, software, and telephone systems. Job Description Diagnose and resolve desktop/lap...

Under moderate supervision, delivers technical training and soft-skills programs to entry-level and experienced staff. Prepares training content with scenarios and exercises geared to audience needs; creates an engaging training environment that promotes learning and successful knowledge transfer. Works closely with teammates and subject matter experts to create both training to troubleshoot...

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...