Manager of Enrollment Services

Manager, Enrollment Services Position Summary

The Manager, Enrollment Services is responsible for ensuring the accurate, compliant, and timely processing of enrollment transactions across enrollment channels. This role oversees enrollment activities conducted within internal platforms and vendor systems, including PBM systems, EDI portals, and related technologies. The position leads a team of Business Analysts and Business Systems Support Administrators who provide cross-functional support for Enrollment Services operations. Key areas of responsibility include Medicare Advantage reconciliation, regulatory compliance monitoring, EDI audits, Member ID fulfillment audits, operational reporting, and data analysis.

Key Responsibilities

• Ensure all Medicare Advantage enrollment activity is accurately reconciled between CMS and internal systems
• Oversee the timely and accurate submission of required reports to regulatory agencies
• Ensure compliance with all applicable federal and state enrollment regulations, policies, and reporting requirements
• Partner with Operations, Information Technology, Compliance, Regulatory Affairs, Customer Service, and other stakeholders to implement mandated process changes and ensure timely adoption
• Serve as the primary point of contact for Government Markets reconciliation activities and represent Enrollment Services during CMS, PID, and DOBI meetings
• Lead enrollment and reconciliation activities during regulatory audits, including preparation, coordination, and organizational readiness efforts
• Present enrollment and reconciliation results during monthly CMS Enrollment Attestation meetings with senior leadership
• Analyze operational metrics and performance data to ensure divisional and corporate goals are achieved while identifying opportunities for process improvement
• Support the Director in developing strategic priorities and operational initiatives for Enrollment Services
• Facilitate recurring meetings to review audit findings, reconciliation outcomes, key performance indicators, and operational insights
• Develop, maintain, and communicate Enrollment Services policies and procedures, ensuring appropriate leadership review and approval
• Ensure appropriate staffing levels, onboarding, training, and professional development opportunities for team members
• Foster a collaborative, high-performing team environment that promotes accountability, engagement, and continuous improvement
• Represent the Director in meetings, projects, and organizational initiatives as needed

Education and Experience

• Bachelor's degree preferred or equivalent combination of education and relevant experience Minimum of 6 years of experience in health plan operations, enrollment services, or a related operational environment
• Minimum of 3 years of direct people leadership or supervisory experience
• Strong knowledge of Medicare Advantage and Commercial enrollment regulations preferred
• Demonstrated experience with federal and state healthcare regulations, enrollment operations, and policy development
• Proven success leading teams and managing cross-functional projects and initiatives

Knowledge, Skills, and Abilities

• Strong understanding of enrollment operations, data processing, operational workflows, and process documentation.
• Advanced proficiency with Microsoft Office applications, including Excel, Word, and PowerPoint; experience with Visio and SharePoint preferred.
• Experience working with enrollment and administrative platforms, EDI enrollment portals, web integration platforms, and workforce management or productivity tracking systems (e.g., Avaya).
• Strong leadership, decision-making, analytical, problem-solving, and strategic thinking capabilities.
• Strong collaboration and relationship-building skills, with the ability to influence stakeholders across all levels of the organization.