Director of Enrollment and Eligibility
Gravie
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $121,275 - $202,125 per year
Job Level
About the role
- Own all eligibility and enrollment operations for employer groups administered by Gravie, including onboarding, open enrollment, life event changes, terminations, COBRA transitions, and ongoing eligibility maintenance.
- Ensure accurate and timely eligibility setup and updates to support downstream claims adjudication, billing, stop-loss reporting, and vendor feeds.
- Establish operational standards, SLAs, and controls to ensure eligibility accuracy across all level-funded plan designs.
- Serve as the escalation point for complex eligibility issues impacting claims payment or member access to care.
- Own eligibility data governance, ensuring consistency across enrollment platforms, claims systems, billing, and external vendors.
- Partner with Configuration, Product and Technology to define eligibility configuration standards, file feeds, and system enhancements.
- Lead testing, validation, and go-live readiness for new groups, plan years, and system changes.
- Drive automation and reduction of manual work to improve speed, accuracy, and scalability.
- Partner closely with Claims Operations to ensure eligibility rules and effective dates support accurate claims adjudication.
- Collaborate with Accounting and Finance to ensure eligibility aligns to premium billing.
- Monitor and mitigate eligibility-related financial risk, including retroactivity, late adds, and termination timing issues.
- Support reconciliation efforts and root cause analysis for eligibility-driven claims or billing discrepancies.
- Ensure eligibility and enrollment processes comply with all regulations and contractual client requirements.
- Create and maintain a balanced scorecard of cost, quality, and time metrics with goals, including implementation, enrollment, eligibility updates, billing, and escalation handling.
- Maintain audit-ready documentation, controls, and reporting.
- Support internal and external audits, client reviews, and regulatory inquiries related to eligibility and enrollment.
- Partner with Legal and Compliance on policy development and risk mitigation.
- Partner with Account Management and Implementation teams to deliver a high-quality employer and member onboarding experience.
- Lead and develop a high-performing eligibility and enrollment team, including managers and individual contributors.
- Define clear roles, workflows, and performance metrics aligned to accuracy, timeliness, and service quality.
- Build training programs and documentation to support consistency and scalability.
- Foster a culture of accountability, ownership, and continuous improvement.
Requirements
- 8+ years of experience in eligibility and enrollment within a TPA, health plan, or benefits administration environment
- 5+ years of people leadership experience, including leading managers
- Deep understanding of eligibility administration and its impact on claims, billing, and funding
- Experience working with enrollment systems, eligibility files, and claims platforms
- Strong operational, analytical, and process design capabilities
Benefits
- Health insurance
- 401k program
- Alternative medicine coverage
- Generous PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- Transportation perks
- Education reimbursement
- Paid paw-ternity leave
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
eligibility administrationclaims adjudicationbillingdata governanceautomationroot cause analysisprocess designfinancial risk managementaudit documentationperformance metrics
Soft Skills
leadershipcollaborationcommunicationproblem-solvingaccountabilitycontinuous improvementtraining developmentteam managementoperational excellenceanalytical thinking