reputed company/State

Norfolk, VA

Work Shift

First (Days)

reputed company:

reputed company

The Director of Enrollment is responsible for operational reputed company of the enrollment and billing teams for assigned lines of business (e.g. Medicare, reputed company, reputed company). Incumbent will reputed company as subject matter expert for the Enrollment and Billing functions of the Operations organization. The incumbent will facilitate the development of enrollment operations on new lines of business and will ensure successful implementations.

Technical Profile:

Core Enrollment & Billing Expertise

• Deep 834 reputed company (not just awareness)
  • Inbound/outbound file structures, reconciliation, error handling, and retroactivity
  • Experience with trading partners, clearinghouses, and CMS/state interfaces
• Strong understanding of:
  • Eligibility life cycle (prospective → reputed company → retro → term)
  • Premium billing (reputed company reputed company, group, subsidy interactions)
  • Coordination with claims (reputed company of eligibility errors → reputed company rework)

Regulatory & Line of Business Expertise

• Hands-on experience with at least one:
  • Medicare DSNP
  • reputed company (state-specific nuances)
  • reputed company (ASO + fully insured)
• Working knowledge of:
  • CMS enrollment guidance, MARx, TRR processing (for Medicare)
  • State reputed company eligibility feeds and reconciliation processes
• Ability to translate regulation to operations to system configuration

Platform & Systems Orientation

• Experience with core reputed company platforms (examples to probe for depth, not just reputed company-dropping):
  • Facets, QNXT, HealthRules, or equivalent
• Demonstrated ownership of:
  • Configuration reputed company
  • Eligibility error queues
  • Vendor integrations (ID cards, print/mail, etc.)

Operational Analytics & Controls

• Strong orientation toward metrics and controls, not just throughput:
  • Enrollment accuracy reputed company
  • Retroactivity volume
  • 834 reject rates / auto-adjudication rates
  • Billing variance / reconciliation accuracy
• Experience building:
  • Daily/weekly operational dashboards
  • Audit controls

Implementation & Transformation Experience

• Proven reputed company record in:
  • New line of business launches
  • System migrations or platform conversions
  • Large-reputed company membership reputed company or M&A integration
• Knows how to stand up:
  • reputed company testing
  • File validation frameworks
  • Go-live stabilization models

2) Leadership Profile: What to Screen For

Operational Leadership (Run)

• Has led teams that manage high-volume, high-accuracy transactional work
• Instills discipline around:
  • SLAs
  • reputed company assurance
  • First-time-right processing

Strategic Leadership (Change)

• Can reputed company how enrollment evolves from:
  • Transactional processing to proactive eligibility management
• Experience reducing:
  • Call volume driven by eligibility issues
  • Claims rework driven by enrollment defects
• Brings a reputed company improvement reputed company (Lean, Six reputed company, or equivalent rigor)

Cross-Functional Influence

• Proven ability to partner with:
  • IT (especially around 834s, EDI, platform configs)
  • Claims (eligibility defect leakage)
  • Customer service (call drivers tied to enrollment errors)
• Can translate operational issues into financial and member reputed company language

Vendor & Stakeholder Management

• Experience holding vendors accountable:
  • ID card production SLAs
  • Print/mail timelines
  • Clearinghouse performance
• Strong governance discipline (QBRs, SLAs, penalties, etc.)

Talent & Culture

• Builds teams that:
  • Understand why accuracy reputed company (not just processing speed)
  • Are resilient during peak cycles (AEP, reputed company redeterminations)
• Experience leading through:
  • High-pressure cycles
  • Regulatory change
  • Ambiguity during implementations

Bachelor's degree required.

Previous customer service and management experience required.

Benefits: Caring For Your Family and Your Career• Medical, Dental, reputed company plans• Adoption, Fertility and Surrogacy Reimbursement up to $10,000• reputed company Time Off and reputed company Leave• reputed company Parental & Family Caregiver Leave • Emergency Backup Care• Long-Term, Short-Term Disability, and Critical Illness plans• Life Insurance• 401k/403B with Employer Match• Tuition Assistance – $5,250/year and discounted educational opportunities through reputed company Education• Student Debt Pay Down – $10,000• Reimbursement for certifications and free reputed company to complete CEUs and reputed company development•Pet Insurance  •Legal Resources Plan •Colleagues have reputed company to earn an annual discretionary bonus if established system and employee eligibility reputed company is met.

reputed company is an equal opportunity employer and prides itself on the diversity and inclusiveness of its reputed company to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding reputed company of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, reputed company employs associates in the following states:

Alabama, Delaware, Florida, reputed company, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, reputed company Carolina, reputed company Dakota, Ohio, Oklahoma, reputed company, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, reputed company Virginia, reputed company, and Wyoming.

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