Enrollment and Eligibility Manager

About The Role

BPHS is seeking an experienced Manager for our new Enrollment and Eligibility Department. This role will manage all operations of the Enrollment, Employer Services, Escalation, and Quality Assurance areas. The role will work

closely with Employers, oversee daily communication (emails, inquiries, and calls), participate in Webinars, and ensure timeliness of daily workflow processes of enrollment and employer file validations, errors, and submissions.

Primary Responsibilities

• Manage the operations of the Enrollment and Eligibility Department, with emphasis on Employer Services. Analyze and manage production volumes, timeliness of data input, Employer portal reporting and workflows, and other variables to ensure optimal service to clients, employers, and caregivers
• Assist the Director/Vice President in developing strategic plans to improve operations, systemize manual processes, enhance systemic processes, evaluate and modify Enrollment and Eligibility policies and procedures to maintain compliance and service-level agreements, and promote efficient department operations
• Support Director/VP in employer, client, and vendor interactions via multi-channel functionalities (calls and emails) to effectively communicate and ensure timely responses to inquiries
• Attend employer/client/vendor meetings and perform Webinars as directed,
• Work closely with Finance management to ensure all employer inquires and work hours are allocated appropriately
• Partner with IT, Operations, and Finance to prepare specifications and testing scenarios to ensure overall functionality of workflow processes and systems
• Participate in the onboarding of clients to include User Acceptance Testing
• Manage special projects and allocate resources as needed
• Make staff selections and employment decisions in accordance with established departmental procedures and Human Resources guidelines
• Develop and support ongoing communication and coordination between the Eligibility, Operations, Customer Services, IT, and Finance management teams to enhance service performance
• Perform additional duties and projects as assigned by management
• Annual travel required to client conference
  
  

Essential Qualifications

• Bachelor’s Degree OR 8 years of equivalent working experience required
• Minimum six (6) years of job-related experience in Health Plan management, including three (3) years of management-level experience with a high level of accountability preferred
• Ability to work alternate schedules/hours based on the business’s needs. Hours are between 9 AM and 9 PM EST, Monday through Friday
• Strong leadership skills and ability to work with all levels of staff and Health Plan management; able to make independent decisions concerning planning, scheduling, and work assignments
• Strong analytical and problem-solving skills; Ability to analyze problems and resolve issues through resolution quickly and methodically
• Knowledge of managed care, labor, and commercial carrier enrollment, and eligibility procedures, including hourly-based eligibility and waiting periods
• Prior experience with premium billing and reconciliation, knowledge of 834 eligibility files and transaction sets a plus
• Experience working with Taft Hartley Trusts
• Fluent in COBRA, FMLA, QLE, QMCSO, and other eligibility-related transactions, a plus
• Moderate proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications
• Ability to multi-task; this includes the ability to understand multiple products and multiple levels of benefits within each product
• Previous experience in quality call monitoring and performance coaching, counseling, and progressive discipline
• Excellent interpersonal and communication skills – oral, written, and listening
• Ability to work remotely as needed and must have an internet service provider to support the MagnaCare remote environment
• Must meet performance standards, including attendance and punctuality
• Other duties as assigned
  
  

About

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: recruiting@brightonhps.com