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Director, Individual Markets Engagement & Operations
Director, Individual Markets Engagement & OperationsTufts Health Plan • Canton, MA, US
Director, Individual Markets Engagement & Operations

Director, Individual Markets Engagement & Operations

Tufts Health Plan • Canton, MA, US
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Director Of Individual Markets Engagement And Operations

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.

Key Responsibilities / Duties : (top five)

  • 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.

Qualifications : (what you need to perform the job)

Education, Certification and Licensure :

  • Required : Bachelor's degree in a related field
  • Preferred : Master's degree : MPH, MBA, or other master's degree with healthcare or financial focus.
  • Experience : (minimum years required)

  • Required : (minimum) 10-15 years of professional experience
  • Preferred : 10-15 years of health plan experience
  • Experience with group commercial and / or Affordable Care Act ("ACA") health plan product management, strongly preferred.
  • Skill 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.
  • Working Conditions and Additional Requirements : (include special requirements, e.g., lifting, travel)

  • 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.
  • The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

    Salary Range : $ -$

    Compensation & Total Rewards Overview : The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. 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 /

    We Welcome All : All applicants are welcome and 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

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