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

The Senior Manager of Product Implementation and Administration will have two main responsibilities: 1) support annual assessment of new product strategies in collaboration with Product Strategy counterparts; and 2) lead key aspects of product implementation and administration processes, including annual bid/rate and related filings, new benefit implementation, and product/vendor management processes.

The Senior Manager will support annual assessment of new product strategies by providing guidance on or helping to research benefit rules and regulations, competitor plan designs/strategies, and other relevant information to inform product decisions. The Senior Manager will participate in product strategy/bid planning meetings led by Product Strategy team to provide subject matter expertise, as needed, on matters related to product design, regulatory requirements, and implementation feasibility. The Senior Manager may also lead some workgroups to help flesh out detailed requirements to support overall product strategy decisions. The Senior Manager will also lead and support the annual new contract/service area application process with CMS.

Once new product designs are approved by senior leadership, the Senior Manager, in collaboration with the Director, is responsible for all necessary product filings with CMS and other regulatory agencies in advance of required deadlines, as well as overseeing implementation of the product across the business. The Senior Manager will be responsible for ensuring that Plan Benefit Packages (PBPs) are reviewed and ready for bid filing in CMS’ Health Plan Management System (HPMS). The Senior Manager will also be responsible for either directly populating the PBPs or will oversee the team’s Product Specialists who populate the PBPs with approved benefit details. The Senior Manager will be responsible for ensuring timeliness, accuracy, and completeness of all bid filings including Actuarial Bid Pricing Tools (BPTs) and other documentation required for complete bid filing. Post-filing the Senior Manager will collaborate with cross functional business partners to lead and oversee key aspects of product implementation, ensuring that all functions are prepared to enroll, service, and deliver the products for the upcoming year. The Senior Manager will play a key role in the document creation/review process to ensure that all communication materials reflect accurate information and meet applicable regulatory requirements and timelines. The Senior Manager works closely with claims, membership operations, clinical services, care management, customer relations, sales, marketing, and other stakeholders to ensure that key deliverables are identified and met. Throughout the year, the Senior Manager will act as subject matter expert in helping to resolve issues related to benefit design and delivery, including participating in standing or ad hoc workgroups as necessary.

The Senior Manager will directly manage one or more Product Specialists while serving as a mentor to other members of the broader Product team who assist with product / system configuration, regulatory applications/filings, and day-to-day benefit adjudication matters.

Overall, the Senior Manager will be responsible for managing a multi-state portfolio with sets of products targeted to meet the unique membership growth and business performance needs of each market. All responsibilities extend to any new Medicare markets should Point32Health choose to expand its footprint in the future.

Key Responsibilities/Duties – what you will be doing

Annual product planning, CMS bid and other regulatory filings

Provide subject matter expertise and other guidance to Product Strategy counterparts to support product and market assessments, including benefit designs, implementation feasibility, and other considerations
Support assessment of vendors (for new services or product enhancements)
Support development and documentation of business cases for new products/initiatives
Collaborate with Actuarial team, as necessary, to finalize product designs and pricing to inform recommendations to senior leadership
Lead preparation and review of Plan Benefit Package (PBP) documentations for bid submission, and partner with Actuarial teams to ensure consistency between PBPs and BPTs prior to bid submission
Manage bid submissions to CMS in coordination with Actuarial team (PBPs, BPTs, Actuarial Bid Substantiation documents, etc.), ensuring timely, accurate, and complete bid filing, timely and accurate response to CMS questions that may arise during desk review, review of Medicare Plan Finder (MPF) for accuracy, etc.
Support other annual regulatory submissions as necessary, e.g., Medicare Supplement product filing with state agencies

New product development & Filings

Oversee or support preparations for and submission of regulatory filings required to launch new products or expand existing ones, including applications for new CMS contracts and/or Service Area Expansion

Product implementation and management

Prepare business functions to service and deliver product designs for upcoming year based on annual regulatory filings, including production of reference tools and product documentation, presentations to business functions, etc.
Oversee or collaborate with Product Specialist to manage Benefit Adjudication Committee meetings and other sub-workgroups as necessary to implement product changes, including directives from regulatory agencies
Lead or oversee meetings with assigned vendors and internal stakeholders to ensure timely and accurate implementation of benefits managed by those vendors
Support AEP readiness by helping to create and manage an oversight structure for key initiatives (such as new vendor implementation, member communication, etc.) that require cross functional coordination for successful implementation
Oversee or lead aspects of the creation and/or review of key documents (including EOCs, ANOCs, and other sales and marketing materials, as well as provider communications) to ensure accuracy of information and that regulatory deadlines are met
Track stakeholder feedback on product performance throughout the year, including Appeals & Grievances to help inform future benefit design guidance, implementation of new benefits or changes to existing benefits
Serve as subject matter expert to all business functions when questions arise regarding benefit design and delivery
Provide oversight of assigned vendors through regular meetings with the vendors and appropriate internal stakeholders to ensure they meet performance and/or address performance issues
Manage or own required Compliance and Procurement FDR reporting processes for assigned vendors

Responsible for direct management and supervision of Product Benefit Specialists who assist with product configuration, regulatory filings, and other day-to-day benefit adjudication matters, including providing appropriate delegation and oversight of project work.

Qualifications – what you need to perform the job

EDUCATION:

Bachelor’s degree required; MBA or other Master’s degree with healthcare focus preferred.

EXPERIENCE:

8-10 years of related business experience with three to five years of experience with Medicare insurance products required. At least two years of CMS bid development and filing experience a plus.

SKILL REQUIREMENTS:

Must possess maturity and a high degree of professionalism.
Must be able to deal with complexity and uncertainty.
Must be a self-starter, be able to think creatively, take responsibility, be extremely resourceful, and have a high energy level.
Must be able to work cooperatively as a team member.

Must be detail-oriented and yet able to see and communicate the big picture to different audiences
Excellent written and oral communication skills.
Comfort with presenting findings in a team environment.

Strong understanding of the managed care industry, preferably Medicare Advantage plans.
Experience in Product Development.
Experience with applicable software and database programs including Excel, Word, PowerPoint.
Strong project management and stakeholder management skills, including ability to manage discrete projects from beginning to end with appropriate level of supervision.
Ability to prioritize and work on multiple projects simultaneously while meeting critical deadlines.
Strong organizational and communication skills, particularly when interacting across various levels of the organization.
Ability to effectively manage and develop high-performing analysts.

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