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We partner with brokers across the nation to improve the way people purchase and access healthcare.
Director of Enrollment and Eligibility
Location
United States
Posted
148 days ago
Salary
$121.3K - $202.1K / year
Seniority
Lead
Job Description
Director of Enrollment and Eligibility
Gravie
• Own all eligibility and enrollment operations for employer groups administered by Gravie, including onboarding, open enrollment, life event changes, terminations, COBRA transitions, and ongoing eligibility maintenance. • Ensure accurate and timely eligibility setup and updates to support downstream claims adjudication, billing, stop-loss reporting, and vendor feeds. • Establish operational standards, SLAs, and controls to ensure eligibility accuracy across all level-funded plan designs. • Serve as the escalation point for complex eligibility issues impacting claims payment or member access to care. • Own eligibility data governance, ensuring consistency across enrollment platforms, claims systems, billing, and external vendors. • Partner with Configuration, Product and Technology to define eligibility configuration standards, file feeds, and system enhancements. • Lead testing, validation, and go-live readiness for new groups, plan years, and system changes. • Drive automation and reduction of manual work to improve speed, accuracy, and scalability. • Partner closely with Claims Operations to ensure eligibility rules and effective dates support accurate claims adjudication. • Collaborate with Accounting and Finance to ensure eligibility aligns to premium billing. • Monitor and mitigate eligibility-related financial risk, including retroactivity, late adds, and termination timing issues. • Support reconciliation efforts and root cause analysis for eligibility-driven claims or billing discrepancies. • Ensure eligibility and enrollment processes comply with all regulations and contractual client requirements. • Create and maintain a balanced scorecard of cost, quality, and time metrics with goals, including implementation, enrollment, eligibility updates, billing, and escalation handling. • Maintain audit-ready documentation, controls, and reporting. • Support internal and external audits, client reviews, and regulatory inquiries related to eligibility and enrollment. • Partner with Legal and Compliance on policy development and risk mitigation. • Partner with Account Management and Implementation teams to deliver a high-quality employer and member onboarding experience. • Lead and develop a high-performing eligibility and enrollment team, including managers and individual contributors. • Define clear roles, workflows, and performance metrics aligned to accuracy, timeliness, and service quality. • Build training programs and documentation to support consistency and scalability. • Foster a culture of accountability, ownership, and continuous improvement.
Job Requirements
- 8+ years of experience in eligibility and enrollment within a TPA, health plan, or benefits administration environment
- 5+ years of people leadership experience, including leading managers
- Deep understanding of eligibility administration and its impact on claims, billing, and funding
- Experience working with enrollment systems, eligibility files, and claims platforms
- Strong operational, analytical, and process design capabilities
Benefits
- Health insurance
- 401k program
- Alternative medicine coverage
- Generous PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- Transportation perks
- Education reimbursement
- Paid paw-ternity leave
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