Operations Expert

About the role

The Operations Expert is responsible for supporting Enrollment and Billing operations for assigned markets. This role serves as a subject matter expert for enrollment, billing, compliance, audit readiness, operational reporting, membership analysis, system implementations, and State-mandated initiatives. The position partners closely with Operations, IT, Sales, Retention, Health Plans, State agencies, and cross-functional business partners to ensure accurate enrollment and billing processing, regulatory compliance, and successful implementation of operational and system changes.

Responsibilities

• Serve as a Subject Matter Expert (SME) for Enrollment and Billing operations supporting assigned markets.
• Maintain enrollment, billing, invoicing, reconciliation, and membership transactions to ensure compliance with State, regulatory, and contractual requirements.
• Support audit readiness activities, compliance reviews, corrective action plans, and implementation of process improvements.
• Partner with IT teams to investigate, troubleshoot, and resolve complex operational and system issues.
• Develop business requirements and support end-to-end testing, user acceptance testing (UAT), production validation, and implementation activities for system enhancements and regulatory changes.
• Support Department of Health (DOH) and other State-mandated initiatives to ensure compliance with evolving State and Federal requirements.
• Analyze enrollment, billing, reconciliation, and membership data to identify trends, risks, operational impacts, and opportunities for process improvement.
• Develop and maintain operational reports, dashboards, membership analyses, and trend reporting to support leadership decision-making, membership growth, and retention strategies.
• Support critical member outreach campaigns, including new enrollment, renewal, and disenrollment outreach initiatives that support member engagement and retention efforts.
• Collaborate with Sales, Retention, Operations, IT, and external stakeholders to support membership growth and retention initiatives.
• Participate in audits, market meetings, and cross-functional workgroups to provide operational expertise and support regulatory compliance efforts.
• Identify opportunities for automation, workflow enhancements, and operational efficiencies that improve the member and customer experience.
• Provide training, guidance, and operational support to staff regarding workflow processes, regulatory changes, and system functionality.

Requirements

• Requires an AA/AS in Information Systems, Health Care Management or Business or related field and a minimum of 3 years of experience in an analytical role including a minimum of 1 year as an enrollment analyst; or any combination of education and experience which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Experience supporting healthcare enrollment and billing operations.
• Knowledge of Medicaid, Commercial, Exchange, or Government Program enrollment and billing processes.
• Experience supporting audits, compliance activities, regulatory implementations, and operational process improvements.
• Strong analytical and problem-solving skills with the ability to evaluate operational and system impacts.
• Advanced Microsoft Excel skills, including pivot tables, formulas, reporting, and data analysis.
• Experience with SQL, Tableau, Power BI, or other reporting and analytical tools preferred.
• Experience gathering business requirements and supporting system testing and implementations.
• Strong communication, presentation, collaboration, and stakeholder management skills.
• Ability to manage multiple priorities and work effectively in a fast-paced, highly regulated environment.