Director, Individual Markets Engagement & Operations

Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

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

Job Summary

The Director of Individual Markets Engagement and Operations is responsible for the overall success of Point32Health’s Individual Markets sales, products and operations, including both the Tufts Health Plan Direct products in MA, as well as the Harvard Pilgrim Health Care products in MA, ME and NH, for combined total of serving over 200,000 members. The Director is accountable for sales performance, broker engagement, distribution channels, member experience, and overall operations. The Director is responsible for ensuring identification of the deliverables necessary to execute on the strategy set by the LOB and coordinating with leaders across the organization to facilitate implementation, establishing a management structure that monitors the performance of established targets, including identifying key performance indicators and for driving operational integration across the two logos in the MA market and ensuring best practices.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Establish key performance objectives, monitor results, and coordinate data-driven recommendations for both sales and operations.
• Accountable for individual market sales and meeting membership targets across three states and two logos through the following channels: direct individual, federal and state-based exchanges, intermediaries.
• Develop multi-year growth strategy for both membership and margin in partnership with the ISG leadership, including all states served, population dynamics and distribution channels.
• Represent both logos with external stakeholders, including broker partners, intermediary channels and exchanges in all states.  Manage all processes related to these partnerships, including providing product portfolio input, marketing, and vendor management, including contract negotiations and execution.
• Responsible for the success of sales team for prospective individual members to assist with plan choice and enrollment. 
• resolving escalated issues related to eligibility, payment, and enrollment.
• Develop productive working relationships with a wide variety of external stakeholders, including brokers, regulators, and advocates.
• Communicate individual market performance indicators and objectives clearly and effectively with all leaders across Point32Health for feedback and approval.
• Responsible for critical ongoing operations related to Federal and State Exchange participation, as well as business process and compliance for newly released regulations, including developing and maintaining processes and policies in compliance with CMS regulations and ensuring that the policies are applied, with the ability to demonstrate ongoing compliance.
• Develop high-functioning team of resources to support effective sales and operations.
• Conduct regular performance reviews and provide key developmental feedback.
• Effectively structure and delegate work to set team up for success.
• Other duties and projects, as assigned.

Qualifications – what you need to perform the job

Education, Certification and Licensure:

• Required: Bachelor’s degree in a related field
• Preferred: Master’s degree: MPH, MBA, or other master’s degree with healthcare or financial focus.

Experience (minimum years required):

• Required: (minimum) 10-15 years of professional experience
• Preferred: 10-15 years of health plan experience
• Experience with group commercial and/or Affordable Care Act (“ACA”) health plan product management, strongly preferred.

Skill Requirements

• Must possess maturity, and a high degree of professionalism.
• Exceptional oral and written communication skills, including for senior most audiences.
• Knowledge of the sales lifecycle, exchange operations and individual consumers.
• Understanding of commercial health plan pricing strategies, including rating development and benefit design optimization.
• Strong understanding of individual insurance products, market dynamics and regulatory environment.
• Self-starter, able to think creatively, take responsibility, and be extremely resourceful.
• Enjoys, and excels, executing in complex environments with significant amounts of uncertainty and ambiguity.
• Must be able to work collaboratively across a highly-matrixed organization, and drive progress through influence.
• Proven ability to build relationships with external stakeholder groups, including regulators and advocates.
• Track record of developing and advancing junior team members and building high performing teams.
• Strong analytical skills, including financial management.
• Significant experience designing quantitative and qualitative data analyses and leveraging them for data-driven decisions.
• Comfort working closely with internal and external clinicians.
• Strong project management and stakeholder management skills.
• Highly-organized; able to effectively delegate to team members and escalate, as appropriate.
• Experience with applicable software and database programs including Excel, Word, PowerPoint and AI-powered software such as CoPilot.

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

• 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.

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Salary Range

$164,034.40 -$246,051.60

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.  The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. 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/

We welcome all
All applicants are welcome and 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 [email protected]