Oversee assigned operational workflows within eligibility and enrollment, ensuring accuracy, compliance, and alignment with CMS requirements.
Manage and develop a small team responsible for execution of day-to-day enrollment and eligibility tasks, fostering a culture of accountability, growth, and continuous improvement.
Analyze enrollment and eligibility data to identify trends, root causes, and performance gaps; translate insights into actionable solutions.
Design and lead cross-functional projects to enhance operational performance and member experience.
Maintain and enhance internal tracking, reconciliation, and audit-readiness protocols.
Monitor vendor performance against SLAs and ensure timely resolution of escalated issues.
Develop and deliver high-quality reports and dashboards for internal stakeholders and senior leadership.
Stay abreast of CMS guidance and evolving regulatory requirements, ensuring that internal procedures remain compliant.
Manage end to end eligibility, enrollment and disenrollment processes.
Partner with end users and business owners to thoughtfully design and deliver AI/automation solutions, translating workflow needs into clear business requirements (scope, rules, dependencies, SMEs/UAT resources), and leading solutions through build, testing/validation, and production rollout.

Requirements

Bachelor’s degree or equivalent experience
3+ years of Medicare Advantage experience
Demonstrated leadership experience, including managing people or operational teams
Strong analytical skills with proficiency in Excel, SQL, or BI tools
Experience collaborating cross-functionally in fast-paced, complex environments
Background in management consulting or healthcare advisory preferred, particularly with exposure to process optimization, operational design, or strategy implementation
Strong understanding of Medicare Advantage regulatory requirements, enrollment/eligibility platforms, and reconciliation tools

Benefits

A competitive salary based on the market
Medical, Dental, and Vision
Employer-Paid Life Insurance
Paid Maternal Leave
Paid Paternal Leave
401(K) match up to 4%
Paid-Time-Off
Employee Assistance Programs
Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

data analysisExcelSQLbusiness intelligence toolsoperational designprocess optimizationreportingdashboard creationAI solutionsautomation solutions

Soft Skills

leadershipteam managementaccountabilitygrowth mindsetcontinuous improvementcollaborationcommunicationproblem-solvinganalytical thinkingproject management

Certifications

Bachelor's degreeMedicare Advantage experience