Director, Enrollment Operations(Duals Special Needs Enrollment Experience Required)

Accountabilities:: Lead end-to-end enrollment operations across assigned markets, including prospective enrollment, auto-enrollment, disenrollment, reinstatement, reconciliation, and related lifecycle activities while maintaining accuracy, timeliness, and SLA performance. Develop and execute enrollment operations strategies aligned with product growth, regulatory requirements, and market expansion. Lead the integration of enrollment operations for newly acquired or merged health plans, including system alignment, data migration, workflow integration, and process standardization. Establish and manage an enterprise enrollment oversight framework incorporating reconciliation methodologies, cross-system validation, dashboards, and executive reporting. Ensure data integrity across internal systems, CMS platforms, and state Medicaid Management Information Systems (MMIS), including platforms such as Facets, MARx, and HPMS. Partner with IT to define system enhancements, data governance practices, integration strategies, and scalable technology solutions. Manage relationships with enrollment vendors and external partners, monitoring SLA performance and driving timely resolution of enrollment exceptions. Lead transformation initiatives involving automation, AI-enabled reconciliation, process optimization, and operational efficiency. Monitor KPIs and enrollment metrics to identify operational risks, compliance gaps, emerging trends, and opportunities for improvement. Lead, develop, coach, and manage high-performing enrollment operations teams while fostering accountability, collaboration, and continuous development. Oversee enrollment, regulatory compliance, financial reconciliation, and vendor reconciliation activities across assigned lines of business. Maintain readiness for CMS, Medicaid, and state regulatory audits, including audit responses, corrective action plans, legislative monitoring, and remediation activities. Oversee CMS 834/820 transactions, state data feeds, and reconciliation processes to ensure accurate and timely enrollment information. Establish and enforce enrollment policies, procedures, controls, and governance standards. Collaborate across business, technology, compliance, finance, and operational functions to deliver strategic and near-term enrollment initiatives. Requirements Bachelor’s degree in accounting, finance, healthcare management, or a related field required; equivalent relevant experience may be considered in lieu of education. MBA or another relevant postgraduate degree is preferred. 7+ years of leadership and management experience. 5+ years of business operations or a similar function, preferably within a healthcare environment. Required experience in Medicaid managed care, Medicare Advantage, Dual Special Needs Plans (D-SNP), or a closely related healthcare environment. Demonstrated experience leading system integrations, mergers, acquisitions, or significant operational transformation initiatives. Deep knowledge of enrollment operations, CMS regulations, Medicaid processes, and healthcare operational workflows. Proven ability to design and operationalize enterprise oversight frameworks, reconciliation models, dashboards, and executive reporting. Familiarity with healthcare and enrollment systems such as TriZetto EAM, Facets, MARx, HPMS, and MMIS platforms. Strong understanding of compliance, audit requirements, regulatory frameworks, and internal and external controls. Ability to develop long-term enrollment strategies while translating them into actionable near-term initiatives. Strong analytical, problem-solving, and decision-making skills, with the ability to manage competing priorities, risks, and deadlines. Demonstrated ability to lead teams through development, engagement, performance management, and organizational change. Strong ability to communicate and influence effectively across all levels of management. Advanced computer skills, including Microsoft Office, with the ability to learn and adopt new technologies quickly. Excellent written, verbal, and interpersonal communication skills, including change-management capabilities. General understanding of IT environments is preferred. Willingness to travel as required by business needs. No professional license or certification is required. Benefits Base salary range of $113,000–$197,700 USD annually. Eligibility for a performance-based bonus tied to company and individual performance. Comprehensive total rewards package supporting employee well-being. Opportunity to lead enterprise-wide enrollment operations across complex healthcare product lines. Strategic exposure to Medicaid managed care, Medicare Advantage, and Dual Special Needs Plan operations. Leadership responsibility spanning enrollment strategy, regulatory compliance, technology integration, vendors, and operational transformation. Opportunity to drive automation, AI-enabled reconciliation, data governance, and process optimization. Collaboration with technology, compliance, finance, operations, and executive stakeholders. Remote work arrangement within the United States. Opportunity to develop and lead high-performing enrollment operations teams. Environment focused on collaboration, partnership, execution, professional development, and continuous improvement.