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

Reporting to the Senior Vice President, Service and Experience, the Director of Provider Services oversees and manages the daily service operations that serve as a centralized point of contact for provider questions and issue resolution across all Point32Health products and markets. The Director, Provider Service is responsible for the following functions: Provider Service Contact Center and management and oversight of all Provider Service BPO relationships. Additionally, the director is responsible for driving operational performance with an eye toward efficiencies and improving the Provider Experience. The Director works closely with Provider Contracting, Provider Operations and Provider relations to ensure a best-in-class Provider experience.

Key Responsibilities/Duties – what you will be doing

Leads a team of Provider Service professionals and ensures that all provider inquiries and issues are addressed in a professional, accurate and efficient manner.
Responsible for identifying the functional needs of a growing and expanding multi-purpose Provider Services department aligning Point32 Health overall strategic provider priorities with opportunities to modernize the operation, expand channel capabilities and enhance the provider experience in a scalable and cost-effective manner.
Partners with workforce planning on creating provider service forecasting and staffing models.
In conjunction with the Quality team, leads QA efforts as it relates to Providers Services. This work includes supporting phone and non-phone work; as well as supporting audits.
Responsible for all vendor management/BPO activities and oversight including strategy, reporting, escalations, performance guarantees, service level agreement development and monitoring.
Works closely with the business to ensure vendors/BPO are delivering on business needs, through the performance of vendor business risk analysis.
Responsible for leading all business process re-design work for Provider Services. Work includes managing in-take requests, assigning work, completing discovery work, presentations, and tracking results. Leverages Design Thinking innovation approach to engage staff and deliver break through efficiencies.
Designs business processes that support operational effectiveness and efficiency and use industry-standard operational metrics to continually benchmark performance against other like service organizations, internal and external.
Drive Self Service adoption and participate on Provider Portal Strategy Team
Responsible for translating and supporting the implementation of key departmental strategies including new provider escalation model and service initiatives.
Represents Provider Services on corporate workgroups and cross departmental initiatives.
Partners with IT to manage, monitor, and enhance system performance, service level agreements, business continuity activities/planning, testing, post lessons-learned activities, and assists in the deployment of pilot events, new services, and technology.
Ensures proper internal control structures are in place to meet regulatory and industry certification requirements. Participates in associated compliance audits and interviews: including but not limited to Centers for Medicare & Medicaid Services (CMS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and Healthcare Effectiveness Data and Information Set (HEDIS).
Responsible for the generation and reporting of data and analysis including the standard weekly and monthly dashboards and provides detailed analysis to ensure business goals are on track. Tracks monthly provider satisfaction surveys, First Call Resolution (FCR) and Net Promoter Score (NPS), for the PS department and related vendors.

Leads Business Continuity efforts for the Department

Qualifications – what you need to perform the job

Skills Required:

Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
Exemplary work history with a proven record of success in positions of progressively greater responsibility managing people and achieving business goals and objectives.
Must understand national/regional/local health care issues, trends, and regulations. Ability to relate this understanding to current and future markets.
Ability to develop strong working relationships and to influence key internal and external constituents to meet critical corporate and community business objectives.
Comprehensive knowledge of Health Plan products including Medicaid and Medicare
Superior people management skills demonstrated ability to design and build effective and diverse work teams.
Outstanding communication skills and the ability to work with all levels within the organization.
Demonstrated competency in the areas of innovation, influence, negotiation, planning, development, and motivation.
Documented strength in analysis, identification of problems and problem resolution.
Must have comprehensive understanding of metrics, leading practices, and relevant technologies for Service Centers.

Education:

BS/BA degree required.
MBA preferred.

Experience:

10 years of experience in a Service Center leadership position
A minimum of 10 years of health care Management experience.

Compensation & Total Rewards Overview

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/

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who 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