Jobs at Harbor Health

Own product definition and evolution of health plan benefits, translate benefit design into system requirements, collaborate with engineering, vendors, compliance, and operations to build claims adjudication, eligibility, and benefits infrastructure that delivers member-friendly cost experiences.

Lead a team handling member and provider grievances, appeals, and escalations. Ensure compliant, documented investigations and resolutions, develop SOPs and QA programs, liaise with Legal/Compliance/Operations, report trends to leadership, and coach staff to drive continuous improvement.

Responsible for end-to-end oversight of delegated entities across Medicare Advantage, Medicaid, and commercial lines. Conduct pre-delegation assessments, audits, and monitoring; manage corrective action plans; ensure compliance with CMS, TDI, NCQA/URAC standards; prepare delegates for audits; maintain audit-ready documentation and performance reporting; coordinate with internal stakeholders.

Investigate, document, and resolve complex member and provider complaints; perform root-cause analysis; ensure compliant resolutions per HIPAA, CMS, and TDI; document actions in CRM; follow up with members and collaborate with Legal, QA, and Operations to address systemic issues.

Conduct phone interviews with members/caregivers to document new medications, adherence, side effects, and barriers. Triage medication information to clinical staff, collaborate with Pharmacy Director and IT to build workflows and collect adherence data, develop outcome metrics, and participate in special projects to improve medication initiation and adherence.

Owner-operator finance role partnering with business leaders and the CFO to build financial forecasts, unit-economics models, scenario analyses, and board-ready materials. Lead zero-to-one initiative financial design, support M&A and corporate development diligence, and contribute to FP&A planning and reporting. Hands-on role that cleans data, builds models, and translates analysis into strategic recommendations.