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 Director of Configuration and Operations of the claim adjudication systems. drives configuration strategy and execution, ensuring accurate setup of claims adjudication, products, benefits, payment processes and automation of business processes. Leads high-performing teams and oversees vendor partnerships to optimize system capabilities and deliver enhancements aligned with organizational goals. Collaborate with senior leadership and cross-functional stakeholders to design scalable, cost-effective solutions that improve operational efficiency and compliance. Serve as a strategic advisor for configuration governance, risk mitigation, and resource planning, reducing administrative costs while enhancing quality and member experience. Champion innovation by envisioning and implementing transformative business processes across the enterprise.

Job Description

• Hires, manages, and trains both direct and non-direct staff with specific domain knowledge in configuration related business applications.
• Continuously evaluates system capabilities to meet business needs and facilitate enhancements.
• Implement and maintain business application systems. Coordinate application upgrades, testing, changes, and patching.
• Defines and monitors key operational metrics, ensuring transparency through clear communication, and driving organizational improvements by addressing performance gaps.
• Drives operational improvement programs, including ongoing development of a cross functional monitoring program and ensure ongoing compliance to regulatory, contract and internal procedures, with an ability to report out on performance, benefit realization as well as monitor and course correct, as necessary.
• Represents Operations at enterprise-wide functional areas across forums; communicates and manages plans, status, risk mitigation.
• Proactively works cross-functionally to identify and manage enterprise-wide interdependencies.
• Designs and implements tactical and operational plans that impact department and related department results.
• Oversees vendor activities, performance, service level requirements, and on-going relationship building.
• Develops project plans specifying goals, strategy, staffing, scheduling, risks, contingency plans, and allocation of available resources as project scope and size require.
• Monitors department performance against goals and targets to ensure timeliness, accuracy, adherence to metrics and take action to address gaps, missed targets and inventory builds.
• Persuades and influences internal and external relationships of critical importance as needed to ensure Operations and organizational objectives are met.
• Other duties as assigned.

Qualifications – what you need to perform the job.

Education, Certification and Licensure

• Required: Bachelor’s degree required or equivalent experience
• Preferred: Master’s degree preferred.

Experience (minimum years required):

• Required: 10-15 years of relevant experience
• Preferred:

Skill Requirements

• Leadership and management skills are necessary.
• Must be able to communicate effectively with all levels of management and work cooperatively as a team member.
• Ability to lead, direct and motivate large teams effectively and manage through influence.
• Superior problem solving and process management skills.
• Ability to prioritize work and operate under very tight deadlines.
• Motivated and flexible, able to work independently.
• Ability to collaborate effectively and regularly with staff at the highest levels of the organization.
• General knowledge of business processes and budgeting protocols
• Possess proven abilities in relationship and change management

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.

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

$151,078.40 -$226,617.60

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, you may contact TA_operations@point32health.org