Majoris Group (Pvt) Ltd
Job type full-time
Full job description
As the senior director of member enrollment and eligibility technical operations, this individual will lead a technical team that supports the delivery of enrollment and eligibility requirements for new client implementations and technical enhancements to meet ongoing client needsThis individual will also lead a team focused on the execution of reconciliation processes for the individual and family exchange businessThis leader will also identify upstream and downstream processes that impact or are impacted by enrollment and eligibility and ensure any technical solutions in any domain account for those impacts.
Under the direction of the vp of member enrollment and eligibility and in partnership with other collaborative leaders, develop, establish and then partner with internal departments and resources to implement and deploy enrollment and eligibility technical strategies that are aligned with organizational goals and focused on our customer/client and consumer experience.
Serve as the business lead to direct implementations of enrollment and eligibility strategies with technology infrastructure, including the hardware and software; work to leverage the latest technologies to support high quality and efficient operations
Identify enrollment and eligibility operations business requirements in response to client and internal opportunities; work with internal departments the to ensure those requirements are mapped to technical solutions where appropriate.
Identify technical solutions and improvements for existing processes, develop business cases to promote those solutions and improvements, and work with the product team to deliver those solutions.
Conduct and provide system performance analysis, file exchange quality and performance analysis, and ensure proper lifecycle/maintenance of all enrollment and eligibility products and tools.
Manage the member enrollment and eligibility product roadmap to ensure appropriate measures are used to prioritize technical/systems projects based on client requirements, quality improvement, regulatory requirements, and potential roi.
Work with external vendors in partnership with internal teams to ensure integration and testing is accurate and complete work collaboratively in a matrixed organization with key internal and external business partners to enable achievement of service level goals and standards, continually enhance the service strategy in alignment with the changing needs of our business and our customers, implementing upgrades, enhancements and/or process improvements as needed.
Perform financial and qualitative analysis of potential and delivered solutions to measure cost, roi and performance
Serve as day-to-day point of contact for other technical and operational domains as it relates to the solution lifecycle; serve on various committees and attends required meetings.
Regularly monitor and report to vp of member enrollment and eligibility performance reports and data to inform decision-making, process design or improvement and program modification or implementation; take timely corrective action and follow-up to ensure positive outcomes.
Escalate risks and issues in coordination with the vp of client finance for status reporting.
Perform other duties and projects as assigned.
**the experience you'll need (required):**
Bachelor's degree in business management/administration, healthcare related discipline or business-related discipline; degrees in an it related fields will be considered when applicable customer service experience is present
10 years of progressive experience with member enrollment and eligibility technical operations, preferably at a health plan, managed care organization, third-party administrator, or other healthcare entity
5 years' experience and extensive working knowledge/proficiency in membership data reconciliation with the centers for medicare and medicaid services (cms), federally facilitated marketplace (ffm), and state exchange organizations.
5 years' experience at a management level position, managing large teams in a technical operations environment
Ability to easily manage and be flexible to fluctuations in demand of work and growth; effectively manage by reporting and strategizing on resource needs.
Exceptional problem solver with the ability to handle difficult situations; proven ability to remain calm in the face of a challenge and comprehension of when and how to escalate an issue.
Strong communication skills (both written and oral)
Strong analytical and organizational skills
Ability to work collaboratively across partner/organizations
Models leadership and takes initiative
Strong working knowledge of communication channel operations (phone, email and live chat systems)
Proficient with microsoft office tools including excel and word
**finishing touches (preferred):**
Mba or master's degree in healthcare, healthcare related discipline or business-related discipline
15 years of progressive experience within an operations environment, preferably at a health plan, managed care organization, third-party administrator, or other healthcare entity
Demonstrated ability to formulate and execute business strategy to meet the strategic needs of the organization.
Advanced written and verbal communication skills with the ability to be persuasive
Project management experience or equivalent experience directing cross-functional teams to successful completion of projects
A proven track record of success with both individual and collaborative problem-solving, showing demonstrable evidence of sound judgment and decision-making
Entrepreneurial mindset geared toward the creation, execution and continuous improvement of health plan operations and implementations
Exceptional organizational skills
Exceptional dynamic listening, communication and presentation skills