Jobs at Point32Health

Analyze and track federal health legislation and regulations, develop policy positions, support federal stakeholder engagement and advocacy, provide technical guidance to business units on implementation of federal guidance, and produce analyses and thought leadership for senior leadership.

Review and manage pharmacy prior authorization requests and coverage determinations, consult with medical directors on complex cases, communicate with members and providers, perform medication management and reconciliation for complex patients, support utilization management policy interpretation, liaise across departments, and participate in quality, risk management, and care coordination activities.

Manage and support cross-functional program operations and vendor relationships. Perform policy and impact analyses, recommend process changes, support planning and implementation of projects, facilitate meetings, track deliverables, and resolve roadblocks to ensure program success.

Lead enterprise underwriting and pricing strategy for large and small group business. Develop rates, underwriting policies, tools, and stop-loss management; direct underwriting operations, analytics, vendor and sales support, and team leadership to balance market penetration and profitability while ensuring regulatory compliance.

The Sr Business System Analyst will lead business process analysis, gather system requirements, and implement technology solutions while collaborating with various departments and mentoring junior analysts.

Lead program performance, regulatory readiness, audit response, and quality improvement for SCO Care Management and D-SNP programs. Own KPIs (Stars, HEDIS, MDS), translate regulatory requirements into operations and training, coordinate cross-functional initiatives, manage a team of program managers, and ensure sustainable implementation of system and policy changes.

Provide strategic leadership for provider partnership and network strategy, aligning contracting, product, clinical, operational, and finance goals. Oversee network, cost, and utilization analytics; design value-based payment and partnership models; grow and optimize networks for adequacy and regulatory alignment; monitor market and policy trends; drive execution of initiatives and sponsor governance, while leading and coaching director-level teams to deliver measurable results.

Execute claims-related disbursements and payment processes, support weekly/monthly payment releases, voids, and invoices. Partner with internal and external stakeholders on operational improvements, vendor and product implementations, and policy/workflow updates. Provide customer service, support audits, and assist on finance operations projects and integration tasks.

Lead month-end and quarter-end close for multiple health plans; manage accounting staff; prepare GAAP and NAIC statutory financials and tax filings; coordinate external audits; develop technical accounting policy and internal controls; support regulatory compliance and special financial reporting projects.

Lead complex behavioral health provider investigations into fraud, waste, and abuse. Conduct data analysis, medical record reviews, and interviews; apply laws, coding and coverage rules; prepare investigative reports and summary findings; recommend recoveries and corrective actions; collaborate with analytics, SIU management, and business units to prevent future loss.

The Lead Financial Planning Analyst supports expense management, budgeting, financial analysis, and reporting for various operational areas, ensuring effective cost control and strategic recommendations.

Lead delivery of complex, high-risk Individual and Small Group product programs. Define portfolio strategy and roadmap, manage cross-functional teams and vendors, oversee P&L and financials, ensure operational readiness, and coach product managers to launch and evolve products across regional markets.

The Director of Network and Provider Analytics oversees analytics for provider contracts and network performance, leads teams, and collaborates with various departments to improve healthcare delivery and operational effectiveness.

The Procurement Category Manager manages vendor relationships, contract negotiations, and performance measurements across indirect categories, ensuring optimal value and risk management.

The Sr Data Analyst manages data submissions for regulatory compliance, oversees data analytics processes, and collaborates with stakeholders to enhance data quality and reporting.

Lead multi-year product strategy and roadmaps for health insurance product lines. Drive product design, enhancements, and discontinuations; lead cross-functional teams; incorporate stakeholder feedback; perform financial modeling and competitive analysis; monitor portfolio performance and recommend course corrections; collaborate on marketing and customer experience; manage vendors and ensure regulatory compliance to meet membership and profitability goals.

The Senior Business Data Analyst handles complex data analyses, collaborates with stakeholders, documents technical specifications, and develops data solutions to meet business objectives, ensuring quality and compliance.

As Vice President of Affordability, you will lead the enterprise strategy to reduce the Total Cost of Care, influence senior executives, and collaborate across departments to improve healthcare affordability and performance.

Lead multiyear network product strategy and cross-functional teams to design, launch, and optimize health insurance network products. Drive compliance with state and federal regulations, financial modeling, portfolio performance monitoring, stakeholder engagement, vendor management, and go-to-market collateral and training to meet membership, profitability, and operational goals.

The Senior IT Internal Auditor evaluates internal controls, assists with audits, prepares audit workpapers, and ensures completion of management action plans.