Director of Group Configuration & Enrollment

Health Plans Inc • Westborough, MA

1d • $150,000 - $170,000

About The Position

The Director of Group, Payment & Enrollment Configuration, Cobra, and Flex/HRA is responsible for directing all operations within these teams reporting to the Vice President of Claims Operations. This role provides strategic and operational leadership for group, payment, and enrollment configuration, 834 set-up and testing, enrollment processing, and COBRA and Flex/HRA administration. Reporting to the Vice President of Claims Operations, this role is accountable for configuration accuracy, eligibility accuracy and data integrity, regulatory compliance, and operational performance.

Requirements

• Bachelor’s Degree (BS/BA) or equivalent.
• Minimum of 10 years’ management experience with claims processing system set up and claims operations, preferably in the healthcare industry
• Advanced skill level in Microsoft Office, including Word, Excel, Outlook and PowerPoint

Nice To Haves

• 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

Responsibilities

• Provide leadership, strategic direction for group, payment, and eligibility configuration, eligibility processing, and eligibility quality assurance.
• Coordinate, 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.
• Documentation of 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.
• Ability to travel to work locations as required.

Benefits

• Reasonable accommodation may be made to enable qualified individuals with disabilities to perform the duties and responsibilities of the position.

What This Job Offers

• Job Type: Full-time
• Career Level: Director