Senior Program Manager

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

Preferred candidate identified.

Under the general direction of the Provider Service Senior Manager, the Senior Program Manager is responsible for supporting the business readiness/needs of the department by participating in and providing business support for Corporate and cross-departmental projects and documenting departmental business requirements. This position requires a high degree of business knowledge and program/project participation. The Senior Program Manager supports the business and needs of the department by providing analysis of current business procedures. Essential functions occur simultaneously; therefore, the Senior Program Manager must have the flexibility to appropriately prioritize deliverables with specified time frames to meet deadlines. Requires experience in a healthcare business environment with knowledge of managed care and insurance issues.

Key Responsibilities/Duties – what you will be doing

Requirements:

• Develop and execute initiatives to ensure a positive provider experience on strategic initiatives like Provider Service Center [PSC] Optimization, the transitioning from one outsourced vendor utilized by Harvard Pilgrim Health Care to the current THP vendor to have an enterprise P32H outsource vendor for all the provider service centers, coverage as part of Commercial Migration and all open enrollment activities that impact the provider service center.
• Analyze voice of the customer and satisfaction data to identify trends to develop actionable insights that drive improvements in service delivery and customer experience.
• Identify and mitigate program risk through proactive planning and collaboration with cross functional teams to reduce impacts to Point32Health and the customer experience.
• Act as the voice of the customer, advocating for their needs and ensuring they are prioritized in decision-making processes
• Must thrive on solving challenges, creating and applying best practices, and excel at managing expectations of both internal and external clients and partners
• Act as a resource to Provider Services for guidance with investigating and communicating operational issues. 
• Manage and track escalated issues as well as assist in resolution.
• Assist Provider Services and Partner Departments with understanding and communicating the processing and handling of complex claims or provider issues.
• Participate in various company/departmental initiatives, projects, or committees as assigned by management.  This may include process improvement initiatives and participating on cross-functional teams.  Flexibility to expand roles and responsibilities as deemed necessary.
• Monitor to ensure timely responses for all escalated provider issues for all lines of business.
• Identify trends and issues that are primarily reported by the Provider Services call center vendor, and report and escalate as needed.

Communication (Written and Verbal):

• Strong verbal and written skills to effectively communicate both detail and at a summary level to all levels of management at Tufts HP.  Ability to present technical information in a way that establishes rapport, persuades others, and gains understanding. 
• Ability to be comfortable in a nonhierarchical, flat organization;
• Thrive in a matrix-management, hands-on environment that demands a consultative approach and solutions that span multiple environments in a business area.
• Proficient in writing clear and concise correspondence.
• Demonstrate strong presentation skills.
• Communicate expectations and provide direction in a clear and concise manner.
• Provide current information that helps staff to solve and/or anticipate problems.