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.

Account Coordinator

Department: Client Services

Location: Westborough, MA; Woburn, MA; or Portland, ME

Description: The Account Coordinator is responsible for assisting the Client Services team with the plan implementation for new clients, as well as assisting with the handling of the overall servicing of account issues for existing clients. For new clients, the Account Coordinator will assist the Account Executive/Account Manager in the coordination of plan implementation by producing and compiling educational materials and assisting with the completion of the WIP form, summary of benefits, and other required internal documents. Will work closely with internal staff to communicate service issues and resolve claim payment issues, and serve as the in-house client contact when the Account Executive/Account Manager is unavailable.  Travel may be required within assigned territory.

The successful candidate will have one to two years’ related experience in the healthcare industry. Will be detail-oriented, organized, and able to handle multiple priorities within specified timeframes; work independently and as part of a team; communicate in a professional manner; and be proficient with Microsoft Office programs, specifically Word, Excel and PowerPoint.

 

 

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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 Claims 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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Provider Pricing Specialist

Department: Technical Resource Unit (TRU)

Location: Westborough, MA

Description: The Provider Pricing Specialist is responsible for managing provider database information, provider association with claims, and the set-up of online customer portals.  Will assist with research to settle claim pricing questions, as well as the provider and member appeal process. Will provide assistance in all department research activities.

The ideal candidate will have a High School Diploma or equivalent; prior experience with 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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Enrollment Specialist

Department: Enrollment

Location: Westborough, MA

Description: The Enrollment Specialist is responsible for timely, accurate entry of enrollment activity for all of Health Plans Inc.’s accounts.  The Specialist will interact directly with coworkers within the department as well as with various staff members from other departments.  Will process enrollment data via variance reports generated from 834 file transmissions, paper and email submissions, and transactions submitted through multiple databases (WebECI and CSIPac).

The ideal candidate will have a High School Diploma or equivalent; prior experience in healthcare industry or an enrollment position 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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Manager of Customer Service

Department: Customer Service

Location: Westborough, MA

Description: Health Plans, Inc. is seeking a dynamic, self-motivated individual with demonstrated experience as an effective leader and coach to join our team as the Manager of Customer Service.  

The Manager of Customer Service is responsible for the day-to-day management of the following business areas: Call Center, Imaging Services, Flex/HRA, Member Appeals and Call Auditing. The Manager is accountable for all impacted performance goals/metrics. The Manager is also responsible for resource planning, hiring, reporting, training, performance assessments and staff development. This position will require regular travel between the Westborough and Quincy offices.

The ideal candidate will have a Bachelor’s Degree or equivalent experience. Must have 5 – 7 years’ experience in a customer service/call center environment, preferably in the healthcare industry.  3 - 5 years’ in a supervisory role required. Must work collaboratively with other departments to resolve issues, have strong decision and problem-solving skills, 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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Case Manager

Department: Care Management Services

Location: Remote Opportunity

Description: The Case Manager is responsible for the coordination of services and cost effective management of health care resources to meet individual members' health care needs and promote positive health outcomes. Will communicate with members/designees, physicians and other health care professional regarding the care management process including information about the role of Health Plans, Inc., the case management program, policies and procedures, benefit coverage, and determinations. 

The ideal candidate will be a Registered Nurse with a valid license in Massachusetts, Maine or New Hampshire. Bachelor’s Degree in Nursing and/or Certified Case Manager preferred. Must have 5 – 7 years’ experience in discharge planning and/or case management that include 3+ years’ in clinical settings. Must have familiarity with URAC, DOL and state/federal regulations; knowledge of CPT and ICD 10 coding a plus.

Must work collaboratively with other departments to resolve issues, have strong decision and problem-solving skills, 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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Intake Coordinator

Department: Care Management Services

Location: Westborough, MA

Description: The Intake Coordinator will effectively accept and respond to calls and inquiries regarding pre-certification, Case Management, and Disease Management services. Initiate and complete notifications which do not require evaluation or interpretation of clinical data. Begin pre-certification processes by initiating system files (or cases) for clinical reviewers. Adhere to Care Management policies and procedures, URAC, state and federal regulations. Provide superior quality customer service to internal and external customers. Will also perform a variety of routine clerical duties (i.e., data entry, filing, sorting mail, assembling and distributing mailings, receiving, storing and distributing supplies).

The ideal candidate will have a High School Diploma or equivalent; Associate’s or Bachelor’s Degree preferred.  2 + years’ prior customer service in the healthcare industry preferred with working knowledge of medical and claims terminology.  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. Bi-lingual (English and Spanish) a plus.

 

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Sr. Analytical Strategy Specialist

Department: Sales Reporting

Location: Westborough, MA

Description: Reporting to the Director of Account Operations, the Sr. Analytical Strategy Specialist will participate in all aspects of health care data analytics fulfillment for Health Plans, Inc.’s clients. This role will perform thorough and complex population health business analyses as well as presentations for our customers.

The ideal candidate will have a Bachelor’s Degree or equivalent work experience (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 Verscend or comparable clinical risk management tool a plus.

 

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Customer Service Representative

Department: Customer Service

Location: Quincy and Westborough, 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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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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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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