Manager, Government Enrollment & Appeals

Capital Blue Cross

Manager overseeing enrollment and billing operations across Medicare Advantage and related programs at Capital Blue Cross. Leading compliance efforts and managing appeals and grievances for government programs.

Posted 5/9/2026full-timeRemote • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $83,800 - $157,890 per yearWebsite

About the role

Key responsibilities & impact

Oversees enrollment and billing operations across Medicare Advantage, Medicare Supplement, CHIP, and ACA products, ensuring accurate eligibility, premium billing, member maintenance, and ongoing operational performance.
Leads Medicare Advantage appeals and grievances, ensuring timely, compliant resolution of member and provider appeals and grievances in accordance with CMS requirements.
Ensures compliance with federal and state regulations, including CMS and applicable program requirements, through effective oversight of policies, procedures, controls, and regulatory reporting.
Directs reconciliation, quality, and performance monitoring activities related to enrollment, billing, and Medicare Advantage appeals, identifying trends, risks, and opportunities for improvement.
Leads audit readiness and regulatory support efforts, including responses to CMS audits, compliance reviews, and internal oversight activities related to enrollment, billing, and Medicare Advantage appeals and grievances.
Partners cross‑functionally with Compliance, Claims, Customer Service, Sales, Product, Finance, IT, and other stakeholders to resolve complex operational issues and ensure enterprise alignment.
Drives process improvement initiatives to enhance accuracy, efficiency, member experience, and regulatory outcomes across all assigned functions.

Requirements

What you’ll need

5 years’ experience in one or more of the following; enrollment, billing, reconciliation.
1 year of staff, team lead or project lead experience.
Experience managing health insurance enrollment and billing operations.
Experience overseeing Medicare Advantage Appeals and Grievances or related regulatory functions.
Experience supporting compliance activities, audits, and operational improvement initiatives.
Knowledge of enrollment and billing operations across Medicare and Individual market products.
In‑depth understanding of Medicare Advantage appeals and grievance regulations and processes.
Familiarity with CMS compliance, audit, and oversight expectations.
Understanding of managed care operational workflows and cross‑functional dependencies.
Bachelor’s degree in business, Health Care Administration, or a related field, or equivalent combination of education and experience.

Benefits

Comp & perks

Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
More

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

enrollment operationsbilling operationsreconciliationMedicare Advantage appealsgrievances managementcompliance activitiesaudit readinessregulatory reportingprocess improvementoperational performance monitoring

Soft Skills

leadershipcross-functional collaborationproblem-solvingorganizational skillscommunication

Certifications

Bachelor's degree in businessBachelor's degree in Health Care Administration