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. Job Summary SUMMARY: Under direction of the management, the Compliance Program Manager II is responsible for managing compliance and regulatory projects and initiatives with significant cross-functional interface and complex regulatory scope. Responsibility may include development of compliance oversight programs as well as management of implementation of federal and state requirements. These responsibilities require some negotiation and risk management skills as well as analytical skills. By using knowledge of the company, the Compliance Program Manager II should be able to resolve most roadblocks to ensure success and progress. The Program Manager II should make recommendations for change by performing risk analysis and by using basic analytical and problem-solving capabilities to support the recommendation. Responsibilities at this level will usually require facilitating cross-departmental meetings as well as negotiations with outside parties and regulators to explain and assess the impact of what's required. The Program Manager II will also interact directly with business functions and departments within Point32Health and others in order to accomplish successful compliance oversight and maintain an effective compliance program. Job Description DUTIES/RESPONSIBILITIES: * Manage ongoing assigned compliance program activities to implement compliance initiatives and/or assess regulatory and compliance risk for the organization. This may include working with multiple areas within the organization to ensure effective, accurate, timely processes and workflows as well as working with regulators to best understand regulatory impact of the work being managed and assess organizational readiness. Use analytic skills to develop or improve oversight and monitoring, provide recommendations, and assess compliance risk. * Assist in overall management of the compliance program key functions, including developing compliance workplans across all elements of our effective compliance program, including (but not limited to): Risk Assessment; Monitoring and Auditing; Effective Communication; Training and Education; Policies and Procedures; Vendor Oversight; Issue correction and remediation. * Perform detailed policy and impact analysis as it relates to the current programs; make recommendations for process and/or policy change to best reflect regulatory guidance and expectations; present to various levels of the organization and management the findings, potential risk areas and remediation options. This includes determining data scope, consulting with many ORGANIZATION staff, performing analyses, and determining both quantitative and qualitative business implications focused on fulfillment of regulatory obligations. * Support management of regulatory audits to ensure timely completion of data and documentation collection, review, and submission. Perform review of regulatory audits results. Support development of responses. Track monitoring of responses and remediation actions. * Lead and/or manage projects and/or initiatives by representing regulatory and compliance expectations and requirements during planning and implementation phases. This may include coordinating issue resolution with relevant functional business areas, and leading and/or facilitating planning and review sessions. * Develop monthly and/or quarterly compliance reporting as required by management and organizational Committees. * Understand regulatory requirement and industry, to help drive a successful compliance program through prevention, detection, and correction of potential issues of noncompliance and/or fraud. QUALIFICATIONS: * Bachelor's Degree or equivalent work experience is required. * 3-5 years of health plan experience with 6-8 years working experience * Regulatory and compliance expertise as well as program management experience, including leading cross -functional initiatives SKILL REQUIREMENTS: * Excellent verbal and written communication skills generally acquired through college or other advanced education is required Well developed verbal and written skills, ability to facilitate planning and review sessions. * High level presentation skills including ability to interface effectively with external contacts and/or clients * Strong analytical skills * Ability to exercise sound judgment and raise issues to appropriate team members or management for resolution * Ability to conceptualize the impact of change and propose new methods of conducting business * Ability to use analytical skills to develop new or implement change to existing program functions * Ability to interpret and explain the implications of planned changes to current state business units * Ability to problem solve and overcome obstacles to ensure successful program operations Technical skills: * Proficiency with MS Office applications (Word, Excel, PowerPoint) * Ability to utilize multiple applications simultaneously Interpersonal skills * Requires the ability to work cooperatively as part of a team. * Must be able to effectively communicate with all internal departments in verbal and written formats. * Requires some presentation experience * Must be able to work in a matrix environment with minimal supervision Security Clearance (if applicable): * The position may require a background investigation and fingerprint form on file with the US Office of Personnel Management. Questionnaire For Public Trust Position (standard form 85P) must be completed and approved. * Access to several secure government websites may be needed. WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: * Must be able to work under normal office conditions and work from home as required. * May be required to attend meetings at other company locations or other external meetings. * 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. 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 https://www.point32health.org/careers/benefits/ 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. 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 [email protected]