Senior Manager, Eligibility

Responsibilities

• Lead, mentor, and manage the Business Intelligence Analysis Unit to ensure strong performance, effective workflows, and a high-quality operational structure.
• Oversee daily, weekly, and monthly Business Intelligence (BI) operations to ensure analyses, reports, and deliverables are accurate, timely, and appropriately escalated.
• Oversee and lead BI Unit testing activities for new system implementations and changes to existing applications; manage priorities, resolve technical issues impacting eligibility operations, and ensure testing results are documented and communicated.
• Review eligibility nightly processes and control reports; analyze trends and variances, identify discrepancies, and direct corrective action in alignment with established policies and procedures.
• Oversee development of Key Performance Indicator (KPI) and ad hoc reports, ensuring strong reporting methodology, efficient workflow, and effective internal controls.
• Ensure data integrity for eligibility and enrollment datasets extracted via PostgreSQL, including hands-on data analysis, reconciliations, validations, and internal control reviews as needed.
• Recommend and implement process improvements to enhance departmental efficiency and effectiveness.
• Identify training needs, ensure cross-training, and foster a collaborative, high-performance team culture.
• Perform hands-on analytical, reporting, and data validation work as needed to support unit operations and ensure continuity of critical processes.
• Perform additional duties and special projects as assigned.

Qualifications

• Bachelor’s degree in Health Information Technology, Healthcare Administration, Public Health, Computer Science, or equivalent experience required.
• Minimum six (6) years of healthcare data analysis and management experience, including experience supervising staff or leading project teams, and three (3) years of supervisory experience required.
• Advanced proficiency in PostgreSQL, with demonstrated experience extracting, validating, and analyzing large eligibility and enrollment datasets.
• Advanced Microsoft Excel skills; working knowledge of Microsoft Word.
• Demonstrated experience leading UAT and system testing for new implementations and system changes, including test case development, issue tracking, and results analysis.
• Strong understanding of multi fund benefit plan structures, CMS requirements, and Medicare Advantage; Taft Hartley plan experience highly preferred.
• Exceptional organizational, analytical, and problem solving skills, with the ability to manage multiple priorities in a high volume environment.
• Strong leadership and communication skills, with the ability to present complex data clearly to stakeholders and guide staff performance.