Teams 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.