Director, Enrollment Operations(Duals Special Needs Enrollment Experience Required)
Core
Strategic and operational leadership for enterprise enrollment operations, overseeing end-to-end member enrollment, data integrity, platform integration, and regulatory compliance across CMS, state Medicaid agencies, and external partners.
Role type
Director, Enrollment Operations
Builds
Enterprise enrollment oversight frameworks, reconciliation models, and operational strategies for product line growth and market expansion.
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, system integration and data migration, vendor relationship management, regulatory compliance (CMS/Medicaid), team leadership, financial and vendor reconciliation, audit readiness, process transformation and automation.
Preferred skills
MBA or post-graduate degree, experience with healthcare systems (TriZetto EAM, Facets, MARx, HPMS, MMIS), IT environment familiarity, change management.
Technologies
CMS platforms, MMIS systems (Facets, MARx, HPMS), Microsoft Office, TriZetto EAM
Responsibilities
Lead end-to-end enrollment operations including prospective enrollment, auto-enrollment, disenrollment, and reinstatement; establish enterprise enrollment oversight frameworks and reconciliation methodologies; partner with IT to define system enhancements and data governance; manage vendor relationships and ensure SLA performance; drive transformation initiatives including automation and AI-enabled reconciliation; monitor KPIs and operational metrics; lead and develop high-performing enrollment operations teams; ensure compliance with CMS, Medicaid, and state regulations through audit readiness and corrective action plans; manage CMS 834/820 transactions and state data feeds.
Seniority
Director, strategic leadership with hands-on operational oversight
