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.

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.
• No direct reports; manages projects in a matrixed environment

Qualifications:

Education:

• Bachelor’s degree
• Project management certification preferred
• Masters degree in Business Administration or related field preferred

Experience:

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

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.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago, 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