Director, Individual Markets Engagement & Operations

Point32Health • Canton, MA

18d • Hybrid

About The Position

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.

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.
• 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.
• Bachelor’s degree in a related field
• 10-15 years of professional experience

Nice To Haves

• Master’s degree: MPH, MBA, or other master’s degree with healthcare or financial focus.
• 10-15 years of health plan experience
• Experience with group commercial and/or Affordable Care Act (“ACA”) health plan product management, strongly preferred.

Responsibilities

• 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.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 1,001-5,000 employees