Client: health insurance company
Job: Manager of Enrollment Services
Location: on-site 3 days per week in Philadelphia, PA
The Manager of Enrollment Services is responsible for ensuring the accurate, compliant, and timely processing of enrollment transactions across Medicare Advantage, Medigap, ACA Individual Consumer, and Electronic 834 enrollment channels.
Core functions include Medicare Advantage reconciliation, regulatory monitoring, EDI audits, Member ID fulfillment audits, and operational data analysis and reporting. This includes oversight of enrollment activities conducted within internal platforms and vendor systems.
This role oversees a team of Business Analysts and Business Systems Support Administrators who provide cross-functional support for Enrollment Services operations.
Responsibilities:
- Ensure all Medicare Advantage enrollment activity is fully reconciled with CMS and internal systems.
- Oversee accurate and timely submission of all required reports to regulatory agencies.
- Ensure adherence to federal and state enrollment regulations, policies, and reporting requirements.
- Partner with internal teams (operations, IT, compliance, regulatory, customer service) to implement mandated process changes and ensure timely adoption.
- Serve as primary contact for Government Markets reconciliation processes; represent Enrollment Services at CMS, PID, and DOBI meetings.
- Act as the enrollment and reconciliation lead for onsite regulatory audits; coordinate preparation and internal readiness.
- Present enrollment and reconciliation results during monthly CMS Enrollment Attestation meetings with senior P&L leadership.
- Analyze operational metrics to ensure corporate and divisional goals are met, including performance and process efficiency.
- Assist the Director in establishing strategic directions for Enrollment Services and broader operational initiatives.
- Facilitate recurring meetings to review audit results, reconciliation outcomes, and analytics insights.
- Develop and maintain Enrollment Services policies and procedures, ensuring Director-level approval and organization-wide communication.
- Ensure adequate staffing, training, and skill development for new and current team members.
- Foster a collaborative team environment that promotes productivity, accountability, and engagement.
- Represent the Director in meetings when needed.
Qualifications
- 4+ years of experience in operational or health plan enrollment environments.
- 2+ years of direct supervisory or people leadership experience.
- Working knowledge of Medicare Advantage and Commercial enrollment regulations strongly preferred.
- Demonstrated experience with federal/state health insurance regulations, enrollment processing, and operational policy development.
- Strong understanding of data processing, operational workflows, and documented procedures.
- Experience with Advantasure, HealthProof, Zelis, Web Integration platforms, EDI enrollment portals, and productivity tracking systems (e.g., Avaya or similar) is a plus
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