Director, Individual Markets Engagement & Operations

Director, Individual Markets Engagement & Operations

Join to apply for the Director, Individual Markets Engagement & Operations role at Point
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Health
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Point
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Health is a leading not‑for‑profit health and well‑being organization dedicated to delivering high‑quality, affordable healthcare. We serve nearly 2 million members and build on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care guided by shared values. We are committed to inclusion and equal healthcare access for everyone regardless of background.

We value the diverse backgrounds, perspectives, and experiences of all colleagues, which helps us serve communities with empathy and understanding.

The Director of Individual Markets Engagement and Operations is responsible for the overall success of Point
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Health’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 – a combined total of over 200,000 members. The Director is accountable for sales performance, broker engagement, distribution channels, member experience, and overall operations. The Director ensures identification of deliverables necessary to execute the strategy set by the LOB and coordinates with leaders across the organization to facilitate implementation, establishing a management structure that monitors performance of established targets and identifies key performance indicators to drive operational integration across the two logos in the MA market, ensuring best practices.

• 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 direct individual, federal and state‑based exchanges, and intermediary channels.
• Develop multi‑year growth strategy for membership and margin in partnership with ISG leadership, including all served states, 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 product portfolio input, marketing and vendor management, contract negotiations and execution.
• Ensure success of the sales team in assisting prospective individual members with plan choice and enrollment.
• Resolve escalated issues related to eligibility, payment and enrollment.
• Develop productive working relationships with a wide variety of external stakeholders, including brokers, regulators and advocates.
• Communicate individual market performance indicators and objectives clearly and effectively with all leaders across Point
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  Health for feedback and approval.
• Handle ongoing operations related to Federal and State Exchange participation, business process and compliance for newly released regulations, developing and maintaining policies in compliance with CMS regulations and ensuring policies are applied and compliant.
• Build a high‑functioning team of resources to support effective sales and operations.
• Conduct regular performance reviews and provide key developmental feedback.
• Effectively structure and delegate work to set the team up for success.
• Other duties and projects, as assigned.

• Required:
  
  Bachelor’s degree in a related field.
• Preferred:
  Master’s degree (MPH, MBA, or other healthcare/financial focus).

• Required:
  
  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 is strongly preferred.

• Possess maturity and a high degree of professionalism.
• Exceptional oral and written communication skills for senior audiences.
• Knowledge of the sales lifecycle, exchange operations and individual consumers.
• Understanding of commercial…