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Senior Performance Optimization Manager


ID: 2015111

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 the Senior Vice President of Service and Operations (SVP), the Senior Performance Optimization Manager is responsible for driving operational and performance excellence across the Service and Operations division (Member and Provider Services, Claims, Member Enrollment and Provider Appeals). The Senior Performance Optimization Manager supports the SVP by providing day-to-day operational guidance and direction to Service and Operations leaders and plays a critical role in driving key projects and strategic initiatives.  

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities: 

  • Partners with stakeholders within Service and Operations and across the organization to resolve complex issues and implement and execute on strategic initiatives.
  • Leads business planning efforts as well as regular business review sessions across the Service and Operations division.
  • Responsible for performance reporting and dashboards including conceptualizing, collection, synthetization and analysis of data to optimize efficiency, drive new initiatives and make data-driven decisions or recommendations.
  • Works with SVP on development, implementation and execution of operational and strategic initiatives
  • Identifies trends, risks and opportunities and recommends best practices and/or operational models to set strategic direction
  • Collaborates with functional leaders to identify performance improvement initiatives that create efficiencies and support corporate goals
  • Manages implementation of operations initiatives in all respects including planning, data collection and reporting
  • Effectively works and leads in a matrix environment to accomplish work across multiple teams
  • Independently problem solves and implements appropriate solutions
  • Leads meetings, organizes content into framework and directs people
  • Other duties as assigned


Supervision Exercised: 

  • Does not directly supervise staff but will lead and oversee the work of cross-functional teams


Supervision Received: 

  • General direction and supervision received from Senior Vice President of Service and Operations




Education Required: 

  • Bachelor’s Degree


Education Preferred: 

  • Master’s Degree in Health Care Administration or Business related field


Experience Required: 

  • 10 years’ experience in healthcare or managed care operations
  • Functional data analytics experience


Experience Preferred/Desirable: 

  • 10 years’ experience in Call Center, Claims and Enrollment is preferred
  • Lean Six Sigma certification preferred
  • Tableau proficiency preferred
  • Project management experience is preferred


Required Licensure, Certification or Conditions of Employment: 

  • Successful completion of pre-employment background check.


Competencies, Skills, and Attributes: 

  • Excellent organizational skills and attention to detail, excellent proof reading and editing skills
  • Exceptional written and oral communication skills; ability to interact with all levels of the organization and any external stakeholders
  • Effective collaborative and proven process improvement skills
  • Superior meeting facilitation skills and experience in leading cross-functional teams in a matrix
  • Demonstrated ability to work independently and execute multiple projects simultaneously
  • Ability to analyze, compile, format and present data to leadership
  • Advanced user in Microsoft Office Suite including Excel, Access, PowerPoint and Visio
  • Demonstrated ability to successfully plan, organize and manage projects
  • Strategic thinker and ability to innovate
  • Strong critical thinking, analytical and creative problem-solving sills
  • Interpersonal skills, proactive, self-motivated and a collaborative team player
  • Excellent judgment and discretion
  • Ability to respond to changing circumstances and handle necessary ambiguous roles


Working Conditions and Physical Effort: 

  • Regular and reliable attendance is an essential function of the position.
  • Work is performed in a remote environment.
  • No or very limited physical effort required. No or very limited exposure to physical risk.

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.