The Investigator I conducts investigations related to fraud, waste, and abuse, focusing on prepayment claims and developing strategies to prevent future issues.

The Investigator I conducts prepayment fraud investigations, develops action plans, and collaborates with teams to address FWA-related issues in healthcare.

The Clinical Pharmacist reviews pharmacy prior authorization requests, ensures compliance with regulations, communicates with stakeholders, and resolves quality issues.

Manage clinical pharmacy operations, lead a team executing pharmacy programs, ensure compliance with regulations, and drive cost-efficiency initiatives.

The Program Manager II oversees projects with significant cross-functional interfaces, manages ongoing program operations, performs policy analysis, leads project initiatives, and ensures efficient workflows with clients and vendors.

This role involves developing and executing strategic initiatives within Point32Health, focusing on product strategy, market evaluation, and cross-functional collaboration to promote Commercial growth.

The Director oversees sales, operations, and member engagement for Individual Markets, ensuring performance against targets and developing growth strategies. They manage partnerships, compliance, and team performance, while fostering stakeholder relationships and driving operational integration across multiple states.

Lead a team to analyze and improve Point32Health's information security environment, developing measures for data confidentiality, integrity, and availability. Collaborate with IT and business organizations to ensure security compliance and communicate security concerns to leadership.

The Sr Community Outreach Representative will educate and enroll eligible members in the Point32Health Duals Plan, building community relationships and leading outreach efforts to drive membership growth.

This role involves managing pre-award and post-award contracts and grants, ensuring compliance with policies, and financial monitoring.

The Appeals and Grievance Analyst manages member appeals and grievances while ensuring compliance with regulations and providing excellent customer service. Responsibilities include documentation, investigation, and resolution of cases.

The Appeals and Grievance Analyst manages member appeals and grievances, ensuring compliance with regulations while providing superior customer service. Responsibilities include case management, documentation, and communication with members and stakeholders.

The Appeals and Grievance Analyst manages member appeals and grievances, ensuring compliance with regulations while providing excellent customer service and benefit interpretation.

The Appeals and Grievances Analyst manages member appeal and grievance cases, ensuring compliance with regulations and providing superior customer service during the process.

The Manager will lead the Risk Adjustment Operations & Provider Consulting team, focusing on program management, provider engagement, and risk adjustment strategies for healthcare services. Responsibilities include analyzing risk score data, managing vendor contracts, leading strategic planning efforts, and developing financial reporting for various health plan products.

Lead the design and delivery of digital solutions for healthcare experiences. Oversee product lifecycle, stakeholder engagement, and team development while enhancing user experiences on digital platforms.

The Director of Network Contracting leads contract strategy and negotiation for provider networks, focusing on membership growth and quality performance. This role manages a team and collaborates across multiple divisions, ensuring effective relationships with strategic providers and compliance with regulations.