WelbeHealth

People Operations

• Drive strategic design, implementation, and overall program management of employee benefit offerings
• Manage health and welfare plans, retirement plans, and other ancillary benefit plans, as well as review and analyze current and new benefit offerings for effectiveness, affordability, and market competitiveness, proposing appropriate modifications
• Support all aspects of employee benefits program compliance including documentation, audits, filings, amendments, eligibility, discrimination testing, and all attributes of benefits employment law and regulations including but not limited to ERISA, HIPPA, IRS, FMLA, and ADA
• Partner with stakeholders to improve internal workflows to ensure a smooth benefit enrollment process, budget forecasting and performance, and overall delivery
• Oversee vendor partnerships to ensure contract obligations are met and service levels are exceeded, as well as conduct renewals, service escalations, regular business performance reviews, and cost management
• Act as the primary point of contact on all escalated benefit questions, working with urgency to meet ongoing team member needs
• Build and deliver effective employee benefit communication campaigns to educate team members, as well as conduct a timely and successful annual open enrollment process and provide reporting and benchmarking, as needed

Manager, People

Analyst

• Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim’s aged inventory by verifying various aspects of the system and claim
• Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies
• Move claims free of processing errors through for full adjudication and return claims with errors back to the claims team for corrections
• Provide feedback to the Oversight & Monitoring Manager on claims processing errors, quality improvement opportunities, and configuration change requests, when applicable

Claims Audit Analyst

Director

• Spearhead the WelbeHealth government affairs function for assigned geography
• Develop and implement an effective engagement strategy that results in outstanding relationships with elected officials and administration staff in designated states
• Oversee and leverage WelbeHealth contract staff, including lobbyists and consultants
• Direct advocacy efforts to facilitate resolution of legislative and regulatory issues
• Communicate WelbeHealth’s policy priorities in order to achieve WelbeHealth’s Government Affairs department goals and initiatives
• Track, synthesize, and communicate internally relevant government policy changes (laws, regulations, guidance) impacting WelbeHealth PACE to internal stakeholders

Director, Government Affairs

Operations

• Partner with QOD and market leadership to implement WelbeHealth’s Quality Improvement (QI) program and on market-level process improvement initiatives
• Onboard and mentor new quality specialist team members
• Support regulatory process improvement, such as leading RCAs
• Conduct additional market-level audits as assigned, as well as review and analyze reports of market-level data including that specified in the QI plan and required by state and federal regulations
• Highlight data trends to the QOD, EDs, or market leaders for process improvement opportunities, as well as provide support through the preparation and successful completion of all state, federal, and mock audits
• Assist the QOD in monitoring corrective action plans, and in overseeing the preparation, implementation, and follow-up of all QI Program Committees, including the Quality Improvement Committee and Participant Advisory Committee
• Organize and gather information for monthly and quarterly CMS meetings with the QOD, ED, Medical Director and other key stakeholders, and act as the liaison to notify regulators of IDT updates such as prospective denial enrollees and involuntary disenrollment requests

Regional Quality Operations Specialist

Human Resources

• Analyze, design, and assist with the administration of organizational compensation programs, including base pay, long and short-term incentives, spot bonuses, and commissions that align with company objectives for recruiting, retention, and employee engagement
• Design and communicate pay structures, grades, budgets, and guidelines
• Advise stakeholders on effective pay decisions that support employee engagement and comply with compensation policies and budget guidelines
• Evaluate jobs and develop and maintain job descriptions and job architecture
• Participate in compensation surveys and research and analyze market competitiveness, pay equity, and compensation trends

Compensation Specialist

• Lead the strategic design and execution of a scalable Eligibility Center of Excellence (CoE), including policy oversight, program segmentation, and end-to-end operational workflows across WelbeHealth’s national footprint
• Direct all day-to-day eligibility operations and performance, including redetermination processing, share of cost oversight and reporting, financial assistance consulting, reconciliation, and participant communications - all with direct accountability for timeliness, accuracy, and compliance
• Establish and manage KPIs, dashboards, and audit routines to track performance, monitor regulatory risk, and drive improvement across eligibility operations
• Build and lead a high-performing team, including managers and front-line staff responsible for hiring, training, coaching, and developing talent to consistently meet organizational goals
• Serve as the executive escalation point for complex eligibility cases and barriers, collaborating with cross-functional leaders to resolve risks and maintain access for participants, while building strong relationships with regulatory partners and advocacy agencies
• Manage cross-functional partnerships with internal teams such as Enrollment, Finance, Operations, and Compliance, to resolve barriers and ensure participants can access and sustain coverage in a timely, compliant, and seamless manner
• Drive enterprise-wide enablement, including internal training, SOPs, and knowledge base management

Senior Director, Eligibility Excellence

General Counsel

• Provide legal advice to the various functions of Welbe Health, LLC and its affiliates and assist the General Counsel and Associate General Counsel
• Maintain current knowledge of key federal and state healthcare laws, such as HIPAA, Anti-Kickback, and Corporate Practice of Medicine
• Provide legal advice on a wide variety of healthcare regulatory matters, such as privacy, patient care, and fraud, waste, and abuse
• Prepare, review, and negotiate contracts arising from a variety of activities and functions
• Assist with a variety of corporate matters, such as overseeing entity formation and required filings
• Complete all required documentation accurately in a timely manner
• Protect privacy and maintain confidentiality of all company procedures and information about team members, participants, and their families
• Follow WelbeHealth policies and procedures and participate in any required Quality Improvement activities, staff training, and meetings

Senior Counsel

Auditor

• Assist with retrospective and concurrent coding for PACE (All-inclusive Care for the Elderly) Dual participants
• Conduct pre-visit chart preparations and post-visit chart reviews
• Oversee audits and participate in provider education programs to ensure compliance with CMS risk adjustments diagnosis coding guidelines
• Work closely with Coding Supervisor in identifying opportunities for HCC coding education

Coding Auditor, Educator

• Lead the WelbeHealth federal legislative and regulatory affairs function with Congress and the Centers for Medicare and Medicaid Services (CMS)
• Develop and implement meaningful engagement strategies to advance federal policy objectives and cultivate relationships with regulators and elected officials
• Effectively leverage WelbeHealth lobbyists and consultants to drive meaningful outcomes
• Lead advocacy efforts to facilitate timely approvals of new PACE applications and resolve regulatory issues impacting implementation or operations
• Serve as federal regulatory and legislative subject matter expert; track, synthesize, and communicate government policy changes impacting WelbeHealth and the PACE industry
• Develop engagement strategies to advance WelbeHealth’s positioning within national PACE trade association and serve as primary point of contact
• Ensure proper documentation and timely dissemination of relevant PACE association materials to designated WelbeHealth subject matter experts
• Create and maintain WelbeHealth engagement points of contact, planning, hosting, and coordinating programs, presentations, and events that showcase WelbeHealth’s mission and values

Director, Federal Government Affairs

• Three-year People Coordinator Rotational Program with induction training and multiple HR rotations
• Participate in rotations including People Analytics, Talent Acquisition Operations, HR Technology/HRIS, Learning, Compensation, Benefits/Leave Management, and People Consulting
• Receive dedicated program management support, access to People team senior leaders and mentorship, and ongoing learning opportunities
• Build a supportive community of peers through cohort-strengthening activities such as social events, development workshops, and catered insight
• Enable WelbeHealth team members by leaning into the diverse People function and gain skills to step into HR specialist roles

People Coordinator

Data Analyst

• Senior Data Analyst uses data to define and build out metrics, KPIs, dashboards, ad hoc analyses, and analytical models in one or more areas: clinical, health plan, human resources, marketing, and financial analytics. The Senior Data Analyst is consultative and will support data-driven business decisions and provide actionable business and operational insights.
• Essential Job Duties:
• Collaborate with business stakeholders to help identify which metrics are most useful to track, how they should be defined, and how they can be improved
• Provide analysis-backed ideas on how to improve status quo, and find new solutions and levers to improve business and clinical efficacy
• Build relationships and trust with business partners and have forward-looking mindset to help HR/People departments adjust to changing landscape
• Use data, information, analysis, and modeling to find ways to improve key metrics and optimize operations and clinical efficacy
• Serve as a subject matter expert for business rules and logic (clinical and non-clinical) to convert information into operational and clinical metrics and KPIs
• Partner with the Enterprise Data Warehouse team in the design and development of a single source of truth repository for the company’s clinical and operational data
• Communicate effectively to business users, stakeholders, and leaders on how business and clinical logic is applied to arrive at KPIs and metrics, why we’re measuring what we’re measuring, and how operational activities link to KPIs, OKRs, etc.
• Job Requirements:
• Bachelor's degree in analytics, data science, math, statistics, or related field required; master’s degree preferred
• Minimum of two (2) years of experience in business analytics, with a focus on converting business information into actionable analysis and insights
• Minimum of two (2) years of experience with business information architecture, business metric governance, metric cataloging and dictionaries
• Minimum of two (2) years of experience with SQL, SAS, Tableau, Power BI, or other analytical and business intelligence tools
• Minimum of two (2) years of experience with Machine Learning or Predictive Analytics
• Minimum of two (2) years of experience with People Analytics, highly preferred
• Experience working in a consultative capacity, guiding business partners to make data-driven decisions; Excellent organizational and communication skills with leaders, stakeholders, and users
• Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
• BENEFITS: Health Coverage on Day 1, Paid Parental Leave, 401K Match.
• PERKS: 17 days of paid time off in year one, 12 company holidays, and 6 sick days
• GROWTH: Career path advancement and leadership opportunities

Senior Data Analyst

Account Manager

• The Enterprise and Onsite Partnerships is passionate about optimizing healthcare delivery and building impactful relationships
• Accountable for coordinating care delivery, scheduling, authorizations, troubleshooting, and workflow design across partners and WelbeHealth teams
• Lead strategy for onsite specialty contracting, operations, and performance management
• Collaborate with internal department leadership to improve participant access to specialty and ancillary care appointments, aligning with PACE center needs
• Oversee onboarding and continuous education for newly contracted providers and drive data-driven accountability