Director Of Eligibility

Director of Eligibility Overview

• The Director of Eligibility oversees strategic and operational processes for member enrollment in health and welfare benefits.
• Lead a critical senior role ensuring compliance with regulatory frameworks and collective bargaining agreements.
• Manage enterprise eligibility systems, focusing on data integrity and system functionality.
• Collaborate with IT to administer Vitech-V3locity systems, ensuring seamless data migrations and upgrades.
• Ensure adherence to ERISA, CMS/MSP rules, and HCRA regulations in all operations.
• Drive strategic planning initiatives to meet organizational goals and improve performance standards.
• Foster a culture of transparency, ownership, and professional development within the team.
• Provide fiduciary oversight for compliance with DOL inquiries and legal document reviews.

Director of Eligibility Key Responsibilities & Duties

• Lead and mentor management and line staff, focusing on accountability and succession planning.
• Oversee strategic planning and process improvement initiatives to exceed operational goals.
• Ensure compliance with ERISA, CMS/MSP, and HCRA regulations in eligibility operations.
• Administer enterprise eligibility systems, managing data migrations and system upgrades.
• Direct appeal processes in collaboration with General Counsel for timely determinations.
• Support functionality of employer and member portals for accurate data transmission.
• Provide administrative review of department budgets and implement expense controls.
• Oversee internal and external eligibility audits, developing remediation plans as needed.

Director of Eligibility Job Requirements

• Bachelor’s degree in Business Management, Health Administration, or related field required; master’s degree preferred.
• Minimum 8 years of senior-level experience in healthcare eligibility and enrollment.
• Minimum 6 years of supervisory experience managing diverse teams.
• Extensive experience with Vitech-V3locity or similar enterprise eligibility systems.
• Deep expertise in ERISA, CMS/MSP rules, and HCRA regulations.
• Exceptional organizational, analytical, and communication skills.
• Proven ability to lead, mentor, and improve team performance.
• Experience presenting complex metrics to executives and board trustees.