Director of Eligibility: Meritain Health

JOB SUMMARY

The Enterprise Eligibility/HRO/COBRA/Director has accountability for the delivery of world class enterprise Eligibility, Cobra, and HRO processes and customer service. This individual works closely with the Vice President of Operations in overall structure, planning, and management as well as with the Eligibility Managers in the development, implementation and enforcement of policies and procedures as they relate to the administration of eligibility,HRO, Cobra, and delivery of service to our members.

ESSENTIAL DUTIES

· Directs the review of operations systems, processes and procedures, and recommends improvements to increase efficiency

· Applies process improvement and re-engineering methodologies and principles to conduct process modernization and optimization initiatives

· Integrate industry best practices into processes

· Ensures production is accurate and meets established metrics

· Acts as business lead for employer portals which support client enrollment and online billing

· Build support staff who can train / demo the web portal

· Responsible for coaching, guiding, and developing employees

· Lead multiple eligibility teams

· Responsible for metrics and overall results within all support teams

· Drives operational excellence

· Completes up-to-date business process documentation

· Identifies, manages, and executes process improvements that yield efficiencies

· Responsible for communication, action plans, and alignment within operations

· Implements business and client improvement plans as identified by the client relationship manager (CRM), including client satisfaction and retention

· Ensures contractual metrics are met

· Coordinate, monitor and carry out project activity to provide Vice President with status of department projects, monthly metrics, and monthly cost center budgets

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES

· Ability to strategically analyze disparate data sets and translate into tactical improvement

· Demonstrated ability to drive culture change at all organizational levels associated with process reengineering efforts

· 3-5 years healthcare insurance industry experience with particular emphasis managing and leading business reengineering solutions

· Ability to create and implement tactical operational improvement plans

· Financial management ability for multiple site and / or projects on both a stand-alone and roll-up basis

· Experience in managing multiple projects under strict timelines and meeting overall objectives

· Experience developing policies, procedures, and implementing strategies to meet objectives of excellence in a dynamic environment

· Experience in developing strategic plans and metrics to measure level of achievement

· Experience supporting a customer application – preferably web based

· Experience in developing and managing to a budget

· Management experience, including distributed, multi-site environments. Able to effectively lead resources in more than one site

QUALIFCATION STANDARDS

· Bachelor’s degree required, college degree in Health Administration preferred; plus

· Minimum eight (8) years experience in healthcare administration, enrollment or eligibility to include a minimum of six (6) years supervisory experience.

· Exceptional organizational, leadership, time management, project management and analytical skills

· Excellent communication and interpersonal skills