Director, Enrollment Operations; Duals Special Needs Enrollment

Job Summary

The Director, Enrollment Operations provides strategic and operational leadership for enterprise enrollment operations across assigned product lines. This role oversees end-to-end member enrollment operations, data integrity, platform integration, vendor coordination, and regulatory compliance across CMS, state Medicaid agencies, internal systems, and external partners.

• Lead end-to-end enrollment operations across markets, including lifecycle activities (prospective enrollment, auto-enrollment, disenrollment, reinstatement), ensuring accuracy, timeliness, and SLA adherence.
• Lead integration of enrollment operations for newly acquired or merging health plans, including system alignment, data migration, and process standardization.
• Establish and lead an enterprise enrollment oversight framework, including reconciliation methodologies, cross-system validation, and executive reporting to ensure data integrity across internal systems, CMS platforms, and state MMIS systems (e.g., Facets, MARx, HPMS).
• Establish and execute enrollment operations strategy aligned with product line growth, regulatory requirements, and market expansion.
• Partner with IT to define system enhancements, data governance, and integration strategies supporting scalability and compliance.
• Manage vendor relationships and enrollment partners, ensuring SLA performance and timely resolution of enrollment exceptions.
• Drive transformation initiatives, including automation, AI-enabled reconciliation, and process optimization.
• Monitor KPIs and operational metrics to identify risks, compliance gaps, trends, and improvement opportunities.
• Lead, develop, and manage high-performing enrollment operations teams.
• Accountable for enrollment, regulatory compliance, financial, and vendor reconciliation activities across assigned lines of business.
• Ensure compliance with CMS, Medicaid, and state regulations by leading audit readiness, audit responses, legislative monitoring, and corrective action plans.
• Manage CMS 834/820 transactions, state data feeds, and reconciliation processes to ensure accuracy and timeliness.
• Establish and enforce enrollment policies, procedures, and internal controls.
• Perform any other job related duties as requested.

• Bachelor's degree in accounting, finance, healthcare management or related field required
• Master of Business Administration (MBA) or other related post-graduate degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Seven (7) years of leadership and management experience required
• Five (5) years of business operations or similar experience is, preferably in a health care environment, required
• Medicaid managed care, Medicare Advantage, Dual Special Needs Plan (D‑SNP), or related healthcare experience required

• Demonstrated experience leading system integrations, mergers, or operational transformations
• Deep knowledge of enrollment operations, CMS regulations, Medicaid processes, and healthcare operational workflows
• Proven ability to design and operationalize enterprise oversight frameworks, including dashboards and reconciliation models
• Familiarity with healthcare systems such as Tri Zetto EAM, Facets, MARx, HPMS, and MMIS platforms
• Strong knowledge of compliance, audit, and regulatory frameworks, including internal and external controls
• Ability to develop long-term enrollment strategy and execute near-term initiatives
• Strong analytical and problem-solving skills with the ability to manage competing priorities and timelines
• Demonstrated leadership capability, including team development, engagement, and performance management
• Ability to effectively interact with all levels of management
• Advan…