Careers

Current Openings:

Health Plans, Inc. (HPI), a Harvard Pilgrim company, is the region’s largest Third Party Administrator (TPA). We provide TPA services primarily for ERISA-governed employee group health plans. We specialize in providing claims processing and care management services to clients that self-fund employee health benefits. With locations in Westborough, Woburn and Quincy, MA, Portland, ME, and Greenville, SC, we provide a comprehensive range of claims and medical management strategies to ensure that our clients’ goal of high quality, cost effective health care for their employees is met and exceeded.

HPI complies with all applicable laws concerning hiring and employment practices and is firmly committed to fostering and maintaining a workplace free from discrimination. We are an equal opportunity employer and we hire, train and promote our employees without regard to race, religion, gender, gender identity, genetic information, age, national origin, sexual orientation, disability, veteran status or any other category protected by applicable law. EEO/AA/M/F/Vet/Disability Employer

Our career opportunities are listed below. We offer an excellent working environment and a competitive wage/benefit package. If you are interested in any of the following positions, please forward a cover letter and resume to jobs@healthplansinc.com or fax to 508-329-4814.

Customer Service Representative

Department: Customer Service

Location: Quincy, MA

Description:  The Customer Service Representative is responsible for providing high quality customer service to members, providers and other customers of Health Plans, Inc. The Customer Service Representative handles inbound calls regarding questions on medical, dental and other benefits.

The ideal candidate will have a High School Diploma or equivalent; 1 – 2 years’ prior customer service in the healthcare industry preferred. Must be able to work independently and as part of a team, be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner. Proficiency with Microsoft Word and Excel required.


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Claims Examiner

Department: Claims

Location: Westborough, MA

Description: The Claims Examiner is responsible for the processing of medical claims in accordance with applicable plan benefits. This position will handle of a specific block of group plans and is integral in maintaining the client/customer relationship with those group plans. The Claim Examiner will also assist claimants, providers and/or clients with problems or questions regarding their claim and/or policies.

The ideal candidate will have a High School Diploma or equivalent; prior experience in claims processing, knowledge of medical terminology and/or billing and coding preferred.  Must be able to work independently and as part of a team, be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner. Proficiency with Microsoft Word and Excel required. 

 

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Plan Building Specialist

Department: Technical Resource Unit

Location: Westborough, MA

Description: The Plan Building Specialist is responsible for new business set-up, renewal updates and day-to-day maintenance of data within the Company’s Healthware system to provide accurate claim processing and administration of benefits.

The ideal candidate will have a High School Diploma or equivalent; 1 – 2 years’ related experience.  Must be able to work independently and as part of a team, be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner.  Proficiency with Microsoft Word and Excel required. 

 

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Population Health Reporting Specialist

Department: Sales Reporting

Location: Westborough, MA

Description: As a key member on our Sales Reporting team, the Population Health Reporting Specialist will participate in all aspects of health care data analytics fulfillment for Health Plans, Inc. clients. The role will perform analysis of client claim experiences, identify strategies using healthcare intelligence, insight and analysis of data, to provide recommendations, and leverage clinical information and technology, process design, change management and evidence to improve the client experience.

The ideal candidate will have a Bachelor’s Degree or equivalent work experience (3 – 5 years’) in public health, health informatics or healthcare management. Candidates must have experience in analytical reporting and be able to manage large data sets in various file formats, knowledge and experience with healthcare data and claims, and comprehension of medical spend concerns and risk scoring methodologies. Must also be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner. Advanced skills with Microsoft Word and Excel required. Experience with Verisk or comparable clinical risk management tool a plus.

 

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Financial Operations Support

Department: Accounting/Financial Operations

Location: Westborough, MA

Description: The Financial Operations Support position will be responsible for a variety of diverse tasks. These tasks include organizing, preparing and monitoring return checks, assisting with various tasks related to our client claim funding process, preparing letters to clients, downloading and formatting various bank statements documents and monthly check registers to support monthly bank account reconciliations, and generating and maintain various reports. This position will interact with all departments within the company, specifically Corporate Accounting and Client Fund Accounting.

The ideal candidate will have previous experience in a fast-paced office. Banking or experience in the healthcare industry a plus. Candidates must be detailed, organized and able to prioritize tasks, work within timeframes and meet deadlines, recognize and maintain confidentiality, and communicate in a professional manner. Proficiency with Microsoft Word and Excel required.

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Director of Accounting

Department: Accounting/Financial Operations

Location: Westborough, MA

Description: Leadership responsibility within the Accounting department.  Responsibilities include: accounts receivable, cash management, accounts payable, payroll, internal controls, and financial reporting for Health Plans, Inc. and its affiliated entities for both internal and external reporting purposes. In addition, this position directs the monthly financial statement closing process and oversees all aspects of tax reporting compliance. The Director will work closely with the Human Resources department to ensure compliance with regulations, resolution of employee issues that are payroll-related, and work on any corporate projects with payroll implications.  

Duties and Responsibilities (other duties may be assigned):

  • Responsible for all financial reporting which includes the analysis and implementation of new accounting principles as well as the documentation of technical accounting matters being contemplated or approved by FASB and other regulatory bodies. 
  • Direct the monthly closing of the general ledger in accordance with the close calendar and within the metrics established by management. In order to close effectively, determine    the appropriate analysis to be done and presented on a monthly basis to ensure    accuracy of the financial results, both on a combined basis as well as looking at individual Company results.
  • Responsible for the oversight of subsidiary monthly financial statements and close process. 
  • Coordinate and complete the financial statement audit by external audit firm.
  • Responsible for all tax related functions for the Company and its affiliated entities. On an on-going basis, work with the external accountants in compiling the required    information in compliance with IRS requirements and review the tax returns prepared by the accountants. 
  • Responsible for accounting policy on asset capitalization and monitoring of actual results.  
  • Oversee bi-weekly payroll processing for Health Plans, Inc. Ensure that payroll    processing is in compliance with Federal, State and local requirements. Oversee the    timely participation of the payroll department in the workers’ compensation audit.
  • Key contributor to the company budget process including but not limited to the annual budget process and periodic reforecasts.
  • Provide overall direction to Accounting staff in the department to carry out company    and department goals and objectives.
  • Ensure the financial statements accurately reflect the required amount of bad debt    reserve to ensure receivables are properly stated at net realizable value.
  • Oversee the daily operations of accounts payable by ensuring company policies and procedures are being followed with respect to processing third party payments and employee expense reimbursements. Oversee participation in required audits in a timely manner as well as oversee the annual 1099 process. Ensure accounts payable staff are providing timely and accurate customer service throughout the company.
  • Key contributor in the SSAE 16 audit process. Understand and assess any changes in the business processes and the impact on internal controls. 

Requirements:

  • Bachelor’s Degree in Accounting/General Business; CPA or MBA preferred.  Minimum of 10+ years’ experience in accounting, including at least 5 years in a management role.  Extensive experience with automated accounting and processing systems required.
  • Extensive knowledge and expertise with financial statement preparation and review as well as application of generally accepted accounting principles.  Must have extensive knowledge and expertise within finance related operational areas and internal controls.  Prior experience with Model Audit Rule, Sarbanes-Oxley, and SSAE16 audits preferred. 
  • Strong organizational, analytical, project management, and communications skills.  Ability to respond to constantly changing circumstances and work under short deadlines.
  • Skilled in fostering teamwork and able to mentor/develop staff. 
  • Ability to travel between work locations is required.

Computer Skills:
Advanced skill level in Microsoft Word, Excel, PowerPoint and Outlook.

 

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Member Appeals Coordinator

Department: Customer Service

Location: Westborough, MA

The Member Appeals Coordinator responsibly and professionally handles all member appeals received by Health Plans, Inc.  This entails following both federal and certain state regulation timelines regarding appeal acknowledgement, review, documentation, processing, and response.  The coordinator works with care management staff, medical reviewers, and legal consultants in order to prepare and present the best possible case for review. The Member Appeals Coordinator routinely interacts with internal and external parties and therefore must project a positive company image.

The Member Appeals work occurs simultaneously, making prioritization an essential job function.

Description:

  • Receive, document and research all appeals submitted on behalf of a member.
  • Provide consistent, detailed tracking of all submitted appeals.
  • Correspond with impacted customers as required and in compliance with federal regulations.
  • Serve as a liaison to multiple departments in the review process.
  • Gather all pertinent information for the decision-making process (e.g., research provider network issues, review phone call history, etc.).
  • Prepare and present cases to internal committees.
  • Regularly and thoroughly complete Member Appeal Dashboard reports.
  • Provide assistance settling claim processing errors and omissions using research and problem solving skills.
  • Be an active participant in team meetings.
  • Ensure that all Member Appeals process documentation is maintained and updated as needed.
  • Continue to be open to, and offer suggestions for, process improvements.
  • Follow HIPAA guidelines and other standard office policy and procedures.

 

Experience/Requirements:

  • Possess initiative, balanced judgment and objectivity
  • Communicate effectively, both verbally and in writing
  • Knowledge of healthcare provider billing procedures
  • Strong interpersonal skills
  • Work independently and as a member of a team
  • Must be detailed, analytical and accurate
  • Knowledge of federal, state and NCQA appeals standards
  • Ability to work within specified timeframes and meet deadlines
  • Proficiency with HIPAA Data file layouts and ECI/MphasiS computing systems preferred
  • Proficiency in Healthware, WebECI, and CSI PAC systems preferred
  • 2 years of college or equivalent work experience
  • 2 or more years experience in healthcare industry
  • 2 or more years experience in claim processing systems

 

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