Director, Enrollment Operations(Duals Special Needs Enrollment Experience Required)
Core
Strategic and operational leadership for enterprise enrollment operations across assigned product lines, overseeing end-to-end member enrollment, data integrity, platform integration, and regulatory compliance.
Role type
Director, Enrollment Operations
Builds
Enterprise enrollment oversight framework, system integrations, and operational strategies for health plans.
Domain
Healthcare / Insurance / Medicaid Managed Care
Required skills
End-to-end enrollment lifecycle management, system integration and data migration, enterprise oversight framework design, vendor relationship management, regulatory compliance (CMS/Medicaid), team leadership, financial and vendor reconciliation, strategic planning, KPI monitoring, policy enforcement.
Preferred skills
MBA, experience with mergers/acquisitions, knowledge of TriZetto EAM/Facets/MARx/HPMS systems, 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 lifecycle activities and system alignment for new plans; Establish enterprise enrollment oversight frameworks and reconciliation methodologies; Partner with IT on system enhancements and data governance; Manage vendor relationships and SLA performance; Drive transformation initiatives including automation and AI-enabled reconciliation; Monitor KPIs and operational metrics; Lead and develop high-performing teams; Ensure compliance with CMS, Medicaid, and state regulations through audit readiness and corrective actions; Manage CMS 834/820 transactions and state data feeds.
Seniority
Director, strategic leadership
