Director, Enrollment Operations(Duals Special Needs Enrollment Experience Required)

Accountabilities:

• Lead end-to-end enrollment operations across assigned markets, including prospective enrollment, auto-enrollment, disenrollment, reinstatement, reconciliation, and related lifecycle activities while maintaining accuracy, timeliness, and SLA performance.
• Develop and execute enrollment operations strategies aligned with product growth, regulatory requirements, and market expansion.
• Lead the integration of enrollment operations for newly acquired or merged health plans, including system alignment, data migration, workflow integration, and process standardization.
• Establish and manage an enterprise enrollment oversight framework incorporating reconciliation methodologies, cross-system validation, dashboards, and executive reporting.
• Ensure data integrity across internal systems, CMS platforms, and state Medicaid Management Information Systems (MMIS), including platforms such as Facets, MARx, and HPMS.
• Partner with IT to define system enhancements, data governance practices, integration strategies, and scalable technology solutions.
• Manage relationships with enrollment vendors and external partners, monitoring SLA performance and driving timely resolution of enrollment exceptions.
• Lead transformation initiatives involving automation, AI-enabled reconciliation, process optimization, and operational efficiency.
• Monitor KPIs and enrollment metrics to identify operational risks, compliance gaps, emerging trends, and opportunities for improvement.
• Lead, develop, coach, and manage high-performing enrollment operations teams while fostering accountability, collaboration, and continuous development.
• Oversee enrollment, regulatory compliance, financial reconciliation, and vendor reconciliation activities across assigned lines of business.
• Maintain readiness for CMS, Medicaid, and state regulatory audits, including audit responses, corrective action plans, legislative monitoring, and remediation activities.
• Oversee CMS 834/820 transactions, state data feeds, and reconciliation processes to ensure accurate and timely enrollment information.
• Establish and enforce enrollment policies, procedures, controls, and governance standards.
• Collaborate across business, technology, compliance, finance, and operational functions to deliver strategic and near-term enrollment initiatives.

Requirements

• Bachelor’s degree in accounting, finance, healthcare management, or a related field required; equivalent relevant experience may be considered in lieu of education.
• MBA or another relevant postgraduate degree is preferred.
• 7+ years of leadership and management experience.
• 5+ years of business operations or a similar function, preferably within a healthcare environment.
• Required experience in Medicaid managed care, Medicare Advantage, Dual Special Needs Plans (D-SNP), or a closely related healthcare environment.
• Demonstrated experience leading system integrations, mergers, acquisitions, or significant operational transformation initiatives.
• Deep knowledge of enrollment operations, CMS regulations, Medicaid processes, and healthcare operational workflows.
• Proven ability to design and operationalize enterprise oversight frameworks, reconciliation models, dashboards, and executive reporting.
• Familiarity with healthcare and enrollment systems such as TriZetto EAM, Facets, MARx, HPMS, and MMIS platforms.
• Strong understanding of compliance, audit requirements, regulatory frameworks, and internal and external controls.
• Ability to develop long-term enrollment strategies while translating them into actionable near-term initiatives.
• Strong analytical, problem-solving, and decision-making skills, with the ability to manage competing priorities, risks, and deadlines.
• Demonstrated ability to lead teams through development, engagement, performance management, and organizational change.
• Strong ability to communicate and influence effectively across all levels of management.
• Advanced computer skills, including Microsoft Office, with the ability to learn and adopt new technologies quickly.
• Excellent written, verbal, and interpersonal communication skills, including change-management capabilities.
• General understanding of IT environments is preferred.
• Willingness to travel as required by business needs.
• No professional license or certification is required.

Benefits

• Base salary range of $113,000–$197,700 USD annually.
• Eligibility for a performance-based bonus tied to company and individual performance.
• Comprehensive total rewards package supporting employee well-being.
• Opportunity to lead enterprise-wide enrollment operations across complex healthcare product lines.
• Strategic exposure to Medicaid managed care, Medicare Advantage, and Dual Special Needs Plan operations.
• Leadership responsibility spanning enrollment strategy, regulatory compliance, technology integration, vendors, and operational transformation.
• Opportunity to drive automation, AI-enabled reconciliation, data governance, and process optimization.
• Collaboration with technology, compliance, finance, operations, and executive stakeholders.
• Remote work arrangement within the United States.
• Opportunity to develop and lead high-performing enrollment operations teams.
• Environment focused on collaboration, partnership, execution, professional development, and continuous improvement.