Job Information
Health Plans, Inc. Manager of Information Systems Operations (Hybrid/Remote) in Westborough, Massachusetts
Health Plans, Inc. (HPI) is a New England-based Third Party Administrator (TPA) of self-funded health and benefit plans. HPI was founded in 1981 to provide comprehensive health plan administration to employers, municipalities and Taft-Hartley plans. Health Plans has grown to become an industry-leading TPA by offering customized self-funded benefit plans to employers, combined with superior customer service and investment in the latest administrative and data-mining technology, and reinsurance (stop-loss) security.
Summary:
The Manager of Information Systems Operations will lead the team responsible for the organization's information systems processes and data management. This role will ensure efficient data transactions, including the coordination of the electronic data interchange (EDI) processes and systems within our self-funded insurance operations, and support the overall operational integrity of our systems. The manager will oversee a team of specialists, requiring expertise in information systems, strong analytical capabilities, and effective leadership skills.
Duties and Responsibilities:
Lead, mentor, and manage a team of information systems specialists, ensuring effective daily operations.
Ensure seamless integration of EDI processes within internal systems (claims systems, IT data tracking and other repositories).
Develop and maintain standard operating procedures for information system operations, including EDI processes.
Monitor and analyze inbound and outbound EDI transaction flows to ensure timely processing and resolution of issues.
Create and manage a system to monitor and manage all inbound and bound EDI files with notification to vendors of file failures, missing files, and file sizes based on designated variance rate.
Implement metrics to track transaction volumes and performance, providing insights for continuous improvement.
Identify and drive process improvements to enhance operational efficiency and accuracy of EDI transactions.
Ensure adherence to industry standards and regulations.
Collaborate with various departments to align IS operations and resolve system-related issues.
Establish and maintain relationships with vendors to support EDI initiatives.
Analyze data to identify trends, troubleshoot issues, and provide insights for decision-making.
Provide training and support to internal staff and trading partners on EDI processes and systems.
Act as a point of contact for EDI-related inquiries and issues.
Requirements:
Bachelor’s degree in Computer Science or Information Systems; significant relevant experience may be considered in lieu of a degree.
Experience in EDI operations, with at least 2 years in a managerial role.
Strong knowledge of EDI standards (ANSI X12, EDIFACT) and protocols (AS2, FTP).
Proficient in EDI mapping and transformation tools (e.g., MuleSoft, Cleo, etc.).
Excellent problem-solving, analytical, and organizational skills.
Strong interpersonal and communication skills, with the ability to collaborate effectively with diverse teams.
Experience with project management and process improvement methodologies is a plus.
Recognize and maintain confidentiality of work materials as appropriate.
Familiarity with self-funded insurance operations and claims processing.
Experience working with data integration and management systems.
Knowledge of programming languages (e.g., SQL, XML) is a plus.
Proficiency in EDI mapping tools and software.
Advanced knowledge of Microsoft Office Suite (Word, Excel, Outlook).
Benefits:
Medical, Dental and Vision Coverage
Prescription Drug Coverage
Fitness Reimbursement Benefit
Tobacco Cessation Program
Employee Assistance Program
Flexible Spending Account & Health Savings Account
401(k) and Profit-Sharing Plan
Bonuses
Generous Paid-Time Off
Volunteer Days
Education Assistance & Professional Development Opportunities
….and much much more!
You can read more about us at hpitpa.com/about-us/careers/
EEO/AA/M/F/Vet/Disability Employer