Director of Group Configuration & Enrollment

Duties And Responsibilities

• Provide leadership, strategic direction for group, payment, and eligibility configuration, eligibility processing, and eligibility quality assurance.
• Cook up, oversee, and manage vendor performance and relationship with external vendor (Alegeus) responsible for handling COBRA and HRA/Flex administration.
• Monitor multiple departmental work/inventory levels and implement daily work/action plan to meet expected turnaround times.
• Oversee team responsible for 834 translation, coordination, and testing and interaction with clients, brokers, and/or vendors.
• Lead strategic staffing and capacity planning based on the volume of new and renewing groups, 834 implementations, manual eligibility transactions, QA needs, etc.
• Oversee staff performance management, production standards, and quality outcomes across assigned teams and intervene with root cause analysis and corrective actions when goals are not being met.
• Establish and monitor performance metrics, KPIs, and SLAs aligned with internal goals and client contractual commitments.
• Overall responsibility for review and maintenance of department policies and procedures.
• Partner with department management to identify team inefficiencies and determine solutions.
• Partner with IT, Analytics, and external partners to improve data integrity, automation, and reporting capabilities that enhance departmental processes and performance.
• Interact with and support other internal HPI departments with research, investigation, operational efficiencies, issue resolution, etc.
• Document all software upgrades and testing which impact group set-up and enrollment.
• Provide guidance and instruction for staff members with respect to decisions and procedures within company systems to result in well-integrated processing and reporting output.
• Represent department on company project teams as needed to achieve company objectives.
• Lead cross-functional projects that support department and company goals.

Qualifications

• Minimum Education Requirements: Bachelor’s Degree (BS/BA) or equivalent.
• Minimum Experience Requirements: Minimum of 10 years’ management experience with claims processing system set up and claims operations, preferably in the healthcare industry.
• Preferred Education Requirements: Bachelor’s Degree (BS/BA) required.
• Preferred Experience Requirements: Ability to effectively present information and respond to questions from groups of executives, managers, providers and customers; Ability to anticipate and understand system interactions, integrations, and dependencies; Ability to develop and manage budgets, policies and procedures that support the business; Strong organizational, analytical, project management, and communications skills; Ability to respond to constantly changing circumstances and work under short deadlines; Skilled in fostering teamwork and able to mentor/develop staff; Advanced skill level in Microsoft Office, including Word, Excel, Outlook and PowerPoint.