The Manager, Enrollment Services is responsible for ensuring the accurate, compliant, and timely processing of enrollment transactions across Medicare Advantage, Medigap, ACA Individual Consumer, and Electronic 834 enrollment channels. This role oversees enrollment activities within internal systems and vendor platforms, including Advantasure, HealthProof, PBM systems, mPulse/H3O, EDI portals, and related solutions.
The Manager leads a team of Business Analysts and Business Systems Support Administrators, providing operational oversight and cross-functional support for Enrollment Services. Key responsibilities include Medicare Advantage reconciliation, regulatory compliance monitoring, EDI audits, Member ID fulfillment audits, operational reporting, and process improvement initiatives.
Ensure all Medicare Advantage enrollment activity is accurately reconciled between CMS and internal systems.
Oversee the timely and accurate submission of reports required by regulatory agencies.
Ensure compliance with federal and state enrollment regulations, policies, and reporting requirements.
Collaborate with Operations, IT, Compliance, Regulatory Affairs, and Customer Service teams to implement mandated process changes.
Serve as the primary contact for Government Markets reconciliation processes.
Represent Enrollment Services in CMS, PID, and DOBI meetings.
Lead enrollment and reconciliation activities during regulatory audits and coordinate internal audit readiness efforts.
Present enrollment and reconciliation results during monthly CMS Enrollment Attestation meetings with senior leadership.
Analyze operational metrics and performance data to ensure business objectives and service levels are achieved.
Support the Director in developing strategic initiatives and operational improvements.
Facilitate recurring meetings to review audit findings, reconciliation results, and operational analytics.
Develop, maintain, and communicate Enrollment Services policies and procedures.
Ensure appropriate staffing, training, and professional development for team members.
Foster a collaborative, accountable, and high-performing team environment.
Represent the Director in meetings and special projects as needed.
Perform additional duties as assigned.
Bachelor's degree preferred or equivalent professional experience.
Minimum 6 years of experience in health plan enrollment, healthcare operations, or a related operational environment.
Minimum 3 years of supervisory or people leadership experience.
Strong knowledge of Medicare Advantage and Commercial enrollment processes preferred.
Experience with federal and state healthcare regulations, enrollment operations, and policy development.
Demonstrated success leading teams and managing cross-functional initiatives.
Strong understanding of operational workflows, data processing, and process controls.
Proficiency in Microsoft Office Suite, including Excel, Word, and PowerPoint.
Experience with Visio and SharePoint preferred.
Familiarity with Advantasure, HealthProof, Zelis, EDI enrollment platforms, web integration tools, and workforce management systems such as Avaya.
Excellent written and verbal communication skills.
Strong leadership, analytical, problem-solving, and decision-making abilities.
Ability to manage multiple priorities, meet deadlines, and drive continuous improvement initiatives.
Must have access to an Android or iOS device compatible with the Microsoft Authenticator application for multi-factor authentication.
Benefits:
We offer a competitive compensation package that includes: