Operations Manager, Member & Provider Services

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

Reporting to Director of Member and Provider Service, the Operations Manager is responsible for providing operational oversight including compliance, program development, evaluation, and performance monitoring. This role assumes management of and accountability for day to day service operations and is the subject matter expert for service operations.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

• Work with Director on development and execution of service strategy




• Identify trends, risks and opportunities to set strategic direction
• Identify key strategic considerations for efficient workflows, best practices, and service models
• Collaborate with functional leaders to identify initiatives that improve service to members and providers, create efficiencies and support product growth and health improvement initiatives
• Synthesize information into impactful materials and presentations to facilitate recommendations to the COO and Executive Teams




• Lead business planning efforts for Member and Provider Service
• Effectively work in a matrix environment to accomplish work across multiple teams in the health plan and health system
• Lead meetings, put content into framework, organize people and drive implementation
• Understand and visualize data, make data driven decisions and create reporting
• Develop, implement, and enhance processes to drive overall performance of service initiatives




• Lead implementation projects assigned in accordance of priority
• Develop methodologies and infrastructure to measure the impact of executed initiatives




• Represents Member and Provider Service as the subject matter expert on corporate initiatives. Makes recommendations related to member and provider service impact and operations. Leads implementation of any resulting work, internal project teams, coordinates communication, training, documentation and reporting.
• Identifies, communicates, and escalates issues to the Director of Member and Provider Service on a timely basis. Independently problem solves programmatic issues and implements appropriate solutions.
• Responsible for ensuring compliance with contractual and regulatory requirements and for effectively documenting the components of the programs necessary for compliance with regulatory standards and submission to external agencies.
• Represent Member and Provider Service in meetings with external auditors and regulators such as the Centers for Medicare/Medicaid Services (CMS), the Department of Health and Human Services (DHHS) and the Executive Office of Health and Human Services (EOHHS).
• Coordinates and tracks the completion of regulatory training for all Member and Provider Service staff, and responsible vendors.

• Develops and oversees the production of regulatory reports and standard KPI reports to monitor and report on overall department metrics and program evaluation. Implement operational enhancements in partnership with Service leadership as they relate to department metrics performance.

• Accountable for timely notification to the Director and Service Manager if operational performance falls below expectations for all lines of business and internal teams within service, including matrixed with vendors. Collaborates with Service leadership, CX Analyst and vendors to identify opportunities for improvement and implement interventions to address opportunities.

Supervision Exercised:

• No direct reports; manages projects in a matrixed environment

Supervision Received:

• Weekly supervision with Director of Member and Provider Service

Qualifications:

Education:

• Bachelor's degree

Education Preferred/Desirable:

• Project management certification
• Masters degree in Business Administration or related field

Experience:

• 5+ years of healthcare/managed care experience.
• 5+ years of service center experience or other applicable work experience
• Project management experience preferred

Certification or Conditions of Employment:

• Pre-employment background check

Competencies, Skills, and Attributes:

• Strategic thinker
• Exceptional written and oral communication skills.
• Excellent organizational skills and attention to detail
• Ability to interact with all levels of the organization, as well as external stakeholders.
• Superior meeting facilitation skills and experience in leading cross-functional teams
• Demonstrated ability to work independently and manage multiple complex projects simultaneously.
• Proactive, motivated, and a collaborative team player.
• Demonstrated ability to adapt quickly to changing priorities.
• Ability to analyze, compile, format, and present data to a variety of stakeholders.
• Strong critical thinking, analytical, and problem-solving skills.
• Proficiency with MS tools including Word, Excel, PowerPoint, Visio and MS Project
• Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives.
• Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project.
• Able to negotiate enterprise solutions with other departments that work interdepartmentally.

Working Conditions and Physical Effort:

• Work is normally performed in a typical interior/office work environment.
• Able to perform some work from a remote environment.
• Fast-paced environment.
• No or very limited physical effort is required. No or very limited exposure to physical risk
• Regular and reliable attendance is an essential function of the position.

Compensation Range

$86,500- $125,500

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees