Compliance Program Manager III

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

Under the direction of the Director or Senior Manager of the department, the Compliance Program Manager III manages compliance programs, regulatory projects and initiatives with significant complexity, risk and/or regulatory scope. Initial key responsibilities will include medium to large scale projects and initiatives, including management of compliance focused regulatory audits. Responsibilities include successful implementation of large cross-functional compliance initiatives and management of a compliance function that helps identify and mitigate risks of noncompliance with complex regulatory requirements and guidance.
These responsibilities require strong negotiation and risk management skills as well as sharp analytical skills. By using knowledge of the company, the Compliance Program Manager III should be able to resolve most roadblocks to ensure success and progress.
The Compliance Program Manager III should make recommendations for change by performing risk analysis and by using basic analytical and problem-solving capabilities to support the recommendation. Responsibilities at this level usually require facilitating cross-departmental meetings and negotiations with outside parties to explain and assess the impact. The Program Manager III will also interact directly and regularly with leadership within the department and within Point32Health to accomplish successful compliance oversight and maintain an effective compliance program.

Key Responsibilities/Duties – what you will be doing

• Management of cross-functional compliance projects and initiatives
• Proactive and solutions-oriented management of compliance initiatives and integration issues, requiring the ability to conceptualize and envision the impact of regulatory and business changes to the internal compliance readiness, and propose ways to meet regulatory obligations by understanding business functions and needs.
• Management of regulatory audits to ensure alignment in approach across compliance departments and with the rest of the organization.
• Evaluating and analyzing regulations and sub-regulatory guidance, interpreting their significance, and recommending policies to ensure compliance.
• As directed, support risk assessments using data analytics and regulatory insights
• Leading and/or managing projects and initiatives by representing regulatory and compliance expectations and requirements during the planning and implementation phases. This includes coordinating issue resolution with relevant business areas and facilitating planning and review sessions.
• Providing support in the overall management of compliance program key functions, including developing compliance workplans across all elements of an effective compliance program, including (but not limited to): Risk Assessment; Monitoring and Auditing; Effective Communication; Training and Education; Policies and Procedures; Vendor Oversight; Issue correction and remediation.
• Support the strategic priorities of the organization and compliance program through annual planning, enhancing compliance functions, and driving future needs to support ongoing compliance development activities.
• Support the development of monthly and/or quarterly compliance reporting as required by management and organizational Committees.
• Understand regulatory requirement and industry, to help drive a successful compliance program through prevention, detection, and correction of potential issues of noncompliance and/or fraud.

Qualifications – what you need to perform the job

Education

• Required: Bachelor’s Degree or equivalent work experience

Experience

• Required: 5-8 years of regulatory, compliance and legislative activities, health insurance operations or legal research or equivalent combination of education and experience . 3+ years of Medicare, Medicaid and/or commercial compliance experience. 

Skill Requirements

• Excellent verbal and written communication skills generally acquired through college or other advanced education is required, ability to facilitate planning and review sessions. Ability to communicate with internal and external constituents at all levels with confidence
• High level presentation skills including ability to interface effectively with internal and external contacts and present technical information in a way that establishes rapport and gains understanding. 
• Ability to exercise sound judgment and raise issues and potential solutions to appropriate team members or management for resolution
• Ability to conceptualize the impact of change and propose new methods of conducting business
• Strong analytical skills to develop new or implement change to existing program functions
• Ability to interpret and explain the implications of planned changes to current state business units
• Ability to problem solve and overcome obstacles to ensure successful program operations

Technical skills:

• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint)
• Ability to utilize multiple applications simultaneously

Interpersonal skills

• Requires the ability to work cooperatively as part of a team.
• Must be able to effectively communicate with all internal departments in verbal and written formats.
• Must be able to work in a matrix environment with minimal supervision

• Using knowledge of the company, able to resolve most roadblocks to program progress. Ability to operate and thrive in a matrixed-management, hands-on environment that demands a consultative approach and solutions environment with minimal supervision. May need to coordinate the participation of other internal contacts to develop and or maintain programs.
• Able to navigate issues using advanced organizational knowledge. Is an effective, strong advocate for the program and negotiates/leads others both internally and externally to participate to ensure success in the program. May be required to coach/mentor less experienced staff and effectively lead in a matrixed environment.
• Proactively identifies conflict/integration issues and leads team members to parse/synthesize issues of the highest complexity. Ability to identify risk out of the larger picture and develop risk analysis for consideration.
• Content knowledge of the specific program. Must be able to converse and lead dialogue on the subject with minimal direction; advanced training in the field related to the program is preferred.
• Must be flexible and a proponent/champion of change, able to conceptualize and envision the impact of change, and propose new ways to do business.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• Fast-paced office environment handling multiple demands.
• Must be able to work under normal office conditions and work from home as required.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• May be required to work additional hours beyond standard work schedule.

Compensation & Total Rewards Overview

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.

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