Team Leader Claims Risk Management Operations

Our goal at FedPoint is to foster an engaging environment for our employees that promotes career growth and supports a work-life balance. From professional development to wellness programs to volunteer opportunities, we have created a culture that puts our employees on a positive pathway to success. About FedPoint FedPoint creates and operates digital benefits marketplaces that make it easy forour millions of federal and military customers to understand, select, and use their benefits.A subsidiary of John Hancock Life & Health Insurance Company, FedPoint was founded in 2002 and is headquartered in Portsmouth, NH. Our mission Create and deliver world-class benefits experiences for our customers, clients, and business partners. Team Leader Claims Risk Management Operations Location: Portsmouth, NH (Hybrid)Employment Type: Full-Time | ExemptDepartment: FLTCIP Care CoordinationReports to: Director of Care Coordination About the Role FedPoint is seeking an experienced and detail-oriented Team Leader Claims Risk Management Operation to lead key risk, compliance, and customer experience functions for the Federal Long Term Care Insurance Program, which processes nearly $400 million in annual claims. This position provides leadership and oversight for a team specializing in Fraud, Waste & Abuse prevention, appeals and reconsiderations, and customer satisfaction, ensuring operational integrity and compliance with federal contract standards. This is an opportunity for a collaborative, analytical leader to make a meaningful impact in a highly regulated and mission-driven environment. Key Responsibilities Lead and develop a team of claims and risk management professionals. Oversee appeals and reconsiderations to ensure timely, accurate, and compliant outcomes. Direct Fraud, Waste & Abuse (FWA) prevention programs, including investigations and enterprise-wide fraud awareness training. Partner with Legal, Compliance, and external auditors to manage risk, ensure regulatory readiness, and support audits. Monitor and analyze customer feedback to identify trends and drive service enhancements. Manage department operations, budgets, performance reviews, and vendor relationships. Represent FedPoint at audits, conferences, and OPM-related meetings and presentations. Qualifications Required Bachelor’s degree in Business, Healthcare Administration, Risk Management, or a related field, or equivalent work experience. Minimum of 2 years of leadership experience, including coaching, staff development, and performance management. Minimum of 2 years of experience in long-term care, claims administration, or healthcare risk management. Proven knowledge of Fraud, Waste & Abuse (FWA) detection, investigation, and compliance processes. Strong understanding of regulatory requirements and audit processes. Demonstrated ability to lead process improvement initiatives and manage multiple priorities. Proficiency in Microsoft Office and data management/reporting tools. Excellent communication, analytical, and problem-solving skills. Preferred Certified Fraud Examiner (CFE) or eligibility to sit for the exam. Experience working under a federal contract (e.g., OPM). Familiarity with SharePoint, Authotrack, and data analytics systems. Schedule: Monday through Friday Hybrid. Tuesdays and Wednesdays in office. About FedPoint FedPoint creates and operates digital benefits marketplaces that make it easy for our millions of federal and military customers to understand, select, and use their benefits. A subsidiary of John Hancock Life & Health Insurance Company, FedPoint was founded in 2002 and is headquartered in Portsmouth, NH. To learn more, visit fedpointusa.com . Why Join Us? At FedPoint, our mission is to create and deliver world-class benefits experiences for our customers, clients, and business partners. We offer a dynamic work environment where innovation and collaboration are encouraged. You'll have the opportunity to make a significant impact while honing your skills and advancing your career. In addition to working for a company with great people and an excellent reputation, what’s in it for you? Generous 401k plan: 100% match of employee's contribution, up to a maximum of 6% salary, vests immediately. Bonus Opportunity: Qualifying employees can earn up to 7% of their salary, based on company performance. (Inquire about eligibility with our recruiter) Lots of paid time off:3 weeks’ vacation, 7 sick days, 3 personal days, and 12 paid holidays Competitive benefits include health, dental, vision, disability, life, legal, flexible spending account (FSA) and Health Savings Account (HSA) options. 6 weeks fully-paid parental leave Tuition reimbursement program to support career goals. Corporate giving and matching gifts program. Volunteer program: Paid time off to volunteer and company-organized volunteering opportunities. A wide variety of personal, professional, and career development programs. Comprehensive wellness program offering a variety of resources and activities to help support your well-being in the following areas: career, financial, mental, emotional, physical, social and community. All offers of employment with FedPoint are conditional upon satisfactory completion of a pre-employment background check. #J-18808-Ljbffr