Director, Product Data Management and Operations

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 organizat