Director, Enrollment Operations(Duals Special Needs Enrollment Experience Required)
Core
Strategic and operational oversight for enterprise enrollment operations across assigned healthcare product lines, ensuring accuracy, data integrity, and regulatory compliance.
Role type
Senior leadership Director of Enrollment Operations
Builds
Scalable enrollment operations supporting growth and changing market needs
Domain
Healthcare (Medicaid managed care, Medicare Advantage, Dual Special Needs Plans)
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
End-to-end enrollment lifecycle management, M&A integration, system alignment, data migration, process standardization, enterprise oversight framework design, reconciliation methodologies, cross-system validation, executive reporting, vendor management, automation, AI-enabled reconciliation, process optimization, KPI monitoring, regulatory compliance, audit readiness, CMS 834/820 transactions, state data feeds, policy enforcement, cross-functional collaboration
Preferred skills
MBA or postgraduate degree, IT environment familiarity, change management
Technologies
TriZetto EAM, Facets, MARx, HPMS, MMIS platforms, CMS platforms, state Medicaid Management Information Systems
Responsibilities
Lead end-to-end enrollment operations including prospective enrollment, auto-enrollment, disenrollment, reinstatement, and reconciliation; Develop and execute enrollment operations strategies aligned with product growth and regulatory requirements; Lead integration of enrollment operations for newly acquired or merged health plans; Establish and manage an enterprise enrollment oversight framework incorporating reconciliation methodologies and executive reporting; Ensure data integrity across internal systems, CMS platforms, and state MMIS; Partner with IT to define system enhancements and integration strategies; Manage relationships with enrollment vendors and external partners; Lead transformation initiatives involving automation and process optimization; Monitor KPIs and enrollment metrics to identify operational risks and compliance gaps; Lead, develop, coach, and manage high-performing enrollment operations teams; Oversee enrollment, regulatory compliance, financial reconciliation, and vendor reconciliation activities; Maintain readiness for CMS, Medicaid, and state regulatory audits; Oversee CMS 834/820 transactions and state data feeds; Establish and enforce enrollment policies, procedures, controls, and governance standards; Collaborate across business, technology, compliance, finance, and operational functions
Seniority
Director, strategic leadership with hands-on operational oversight
