Manager, Enrollment Operations (Health Plan Enrollment experience required)
Core
Lead the Enrollment team to ensure operational efficiency, quality outputs, and compliance with regulatory standards for health plan enrollment.
Role type
Manager, Enrollment Operations
Builds
Accurate member eligibility data, enrollment reconciliations, and audit responses for health plans.
Domain
Health Insurance / Healthcare Administration
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Health plan enrollment processes, Medicaid/Medicare/Dual coverage programs, HIPAA 834/EDI 270/271/DTRR file processes, enrollment reconciliation, regulatory compliance, staff management, performance appraisal, conflict resolution, data analysis, change management, risk management.
Preferred skills
Facets subscriber/member setup, Customer Service application, database management, IT requirements definition.
Technologies
Facets, Customer Service application, 834, DTRR, HIPAA, EDI 270/271
Responsibilities
Manage staff and daily operations, oversee financial and member enrollment reconciliation, manage vendor eligibility extract processes, lead audit engagements, analyze departmental performance data, develop corrective action plans, hire and train direct reports.
Seniority
Manager, hands-on leadership