Director of Eligibility Operations
Job in
Chicago, Cook County, Illinois, 60290, USA
Listed on 2026-07-21
Listing for:
Jobtailor
Full Time
position Listed on 2026-07-21
Job specializations:
-
IT/Tech
IT Business Analyst, Business Systems & Technology Analysis, AI Business & Operations
Job Description & How to Apply Below
Responsibilities
- Own the eligibility product roadmap, annual planning, and enhancement prioritization.
- Translate client and operational requirements into development-ready specifications.
- Own benefit-level configuration oversight and vendor integration strategy.
- Identify automation and AI‑assisted workflow opportunities within the eligibility function.
- Own the eligibility function's contribution to platform migration initiatives, including testing sign‑off, migration validation, and post‑go‑live stability.
- Keep the team's work visible to leadership through dashboards, reporting, or equivalent tools.
- Provide strategic oversight to the EDI/Eligibility Manager and maintain ultimate accountability for team performance and quality.
- Represent the eligibility function in client conversations and cross‑functional leadership discussions.
- 10 or more years in healthcare eligibility, EDI operations, or PBM/health plan benefit administration.
- Expert knowledge of X12 834 and 270/271 transaction sets with hands‑on troubleshooting experience.
- Working SQL proficiency and familiarity with Snowflake or comparable cloud data platforms.
- Demonstrated experience owning or leading an eligibility or EDI function at a senior level.
- Experience managing operational continuity through active platform migrations or system transitions.
- Proven ability to lead through influence and own a product roadmap.
- Strong communicator across technical and non‑technical stakeholders, including clients and executives.
Demonstrates extensive expertise in healthcare eligibility and EDI operations, with a strong focus on product roadmap ownership, strategic oversight, and cross‑functional leadership. Proficient in managing platform migrations and leveraging automation to enhance operational efficiency.
Tools & Technologies- SQL
- Snowflake
- Dashboards
- Reporting Tools
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