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Senior Manager, Compliance

2 months ago

Massachusetts, United States Point32Health, Inc. Full time

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here.

Job Summary

The Senior Compliance Program Manager will be responsible for
development, implementation and management of complex compliance programs and initiatives including annual and ad hoc programs, initiatives, projects associated with multiple business lines and may involve state and federal regulations. These programs and initiatives involve the most critical
programs/ projects and partnering with internal department interfaces and external stakeholders and may include government regulators and auditors. These projects/programs will be of the highest complexity, risk and/or regulatory scope, will involve multiple business areas, multiple lines of business, and potentially IT.

The Senior Compliance Program Manager will be responsible for collaborating with leadership, teams and partnering departments to define and execute strategic compliance initiatives in order to accomplish successful compliance oversight and maintain an effective compliance program.

Key Responsibilities/Duties - what you will be doing

Key Responsibilities
* Overall compliance program ownership and management key programs, focusing on both shortterm initiatives and long-term strategic direction and objectives for the programs.
* Ensuring ongoing compliance with established, revised, or new regulatory requirements that
impact the delivery of benefits for members.
* Oversee the compliance program through employee and leadership communications,
coordination of policy development and ensure accurate and timely communication to all
departments.
* Prepare monthly and/or quarterly compliance reporting for the organization's leadership and
organizational Committees.
* Evaluate and analyze regulations, interpret significance, and recommend policies to comply and
apply and ensure compliance to applicable regulations.
* Investigate instances of suspected noncompliance within the health plan and report to
appropriate management and regulatory entities.
* Identify risks within the context of the broad projects and accurately estimate and plan resource
usage accordingly.
* Assist management with enforcement and discipline in appropriate instances of noncompliance.
* Support management of the compliance program key functions, including developing
compliance workplans across all elements of our effective compliance program, including (but
not limited to):
oRisk Assessment, Monitoring and Auditing
oEffective Communication
oTraining and Education
oPolicies and Procedures
oVendor Oversight
oIssue correction and remediation
* Interact and communicate effectively with state and federal regulators.
* Oversees department staff contributing to highly critical projects;
* Exercises judgment to make decisions, or to raise issues to the appropriate level in a timely
manner.

Qualifications - what you need to perform the job

EDUCATION: (Minimum education & certifications required)
* Requires a Bachelor's Degree with a Master's degree preferred

EXPERIENCE: (Years of experience)
* 10 or more year's business or industry experience. 8 + years of compliance and regulatory expertise, including leading the most cross -functional high-level initiatives.
* Significant business process and project management experience related to the implementation of healthcare insurance business applications and products using industry-standard project and program management tools and techniques with established track record.
* A proven ability to meet deadlines is also required.

SKILL REQUIREMENTS: (Include interpersonal skills)
* Ability to thrive in a matrix-management, hands-on environment that demands a consultative approach and solutions that span multiple environments in a business area.
* Outstanding communication and relationship management skills required, including the ability to effectively manage difficult group dynamics to effectively reach a positive outcome; very strong situation leadership skills.
* Excellent human resource management skills, ability to oversee team of project managers as part of the overall program
* Highly developed oral and written communication skills, ability to communicate with and influence internal and external constituents at all levels with confidence.
* Highest level presentation skills including ability to interface and "sell" new programs and changes to existing programs to a broad range of internal and external contacts, as necessary.

Strong negotiating, influencing, and advocacy skills, ability to lead others both internally and externally to ensure the success of the program.
* Ability to navigate political issues using advanced organizational (Tufts HP) knowledge.
* Must be flexible and a proponent/champion of change, able to conceptualize and envision the impact of change, and propose new ways to do business.
* Must be an accomplished multi-disciplinary team-leader and team-builder with hands-on style.
* Ability to balance strong leadership on day-to-day program management and significant issues while also aligning with program director's broader needs and vision for the program.
* Ability to present technical information in a way that establishes rapport, persuades others, and gains understanding.
* Possess strong influencing and situational leadership skills with the ability to manage and motivate both direct and non-direct reports. Must have a demonstrated ability to obtain the confidence and trust of non-reports, resulting in high commitment and cooperation.

Compensation & Total Rewards Overview

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

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do-from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who 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.

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