Manager, Enrollment Operations – Health Plan Enrollment Experience Required

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide guidance and oversight to the Enrollment team.

• Ensure that departmental and CareSource objectives and standards are achieved.

• Manage personnel to guarantee the timely, accurate, and high-quality completion of service items.

• Oversee financial and member enrollment reconciliation for designated lines of business.

• Supervise vendor eligibility extract processes.

• Ensure adherence to regulatory requirements.

• Manage enrollment technology, process analysts, and activities related to 834 and DTRR file processes, along with departmental policies and procedures.

• Oversee enrollment audit engagements and formulate corrective action plans as necessary.

• Collect, analyze, and report department performance data while recommending process enhancements.

• Engage in the development of new products and technologies.

• Manage daily operations and projects through effective resource allocation.

• Develop and sustain knowledge of the company’s business and regulatory landscapes.

• Implement change management and risk controls.

• Recruit, train, coach, and develop direct reports, including conducting performance appraisals and handling disciplinary actions.

• Mentor team leads and team members.

• Perform additional related duties as assigned.

⛳️ Requirements

• A Bachelor’s degree is required, or equivalent years of relevant work experience may be accepted in lieu of required education.

• A minimum of three (3) years of leadership/management experience is required.

• At least three (3) years of enrollment/reconciliation/call center experience is required.

• A strong understanding of health plan enrollment processes is essential.

• Expert proficiency in Facets subscriber and member setup, benefits eligibility including COB, and familiarity with the Customer Service application is preferred.

• Knowledge of Medicaid, Medicare, and Dual coverage programs, including enrollment requirements and regulatory compliance.

• Familiarity with HIPAA 834, EDI 270/271, DTRR, MMR, and other industry-standard enrollment files and data exchange processes.

• Knowledge of enrollment reconciliation is preferred.

• Strong understanding of regulatory reporting and compliance requirements is preferred.

• Proficient in online services and eligibility search functions.

• Effective people management and leadership skills are necessary.

• Strong knowledge of database management is desired.

• Experience working with IT teams and providing requirements is essential.

• Ability to prioritize and execute tasks in a high-pressure environment.

• Capable of diffusing tension and managing conflict.

• Advanced written and verbal communication skills are required.

• Excellent mentoring and coaching abilities.

• Strong decision-making and problem-solving skills.

• Robust critical thinking, listening, and analytical skills.

• Licensure and certification: None required.

• General office environment; may require sitting or standing for extended periods.

🏝️ Benefits

• Bonus opportunities linked to company and individual performance may be available.

• A substantial and comprehensive total rewards package.

• Support for employee total well-being.