Eligibility Specialist

We are seeking an experienced Director of Eligibility Operations to lead enrollment and eligibility operations for one of the largest multi-employer benefit funds in the region.

This is a high-impact senior leadership role overseeing the enrollment of members, spouses, and dependents for health and welfare benefits while ensuring compliance with complex CBA and regulatory requirements
.

• Oversee and develop a large Eligibility Operations team, including management and line staff
• Drive strategic planning, process improvement, operational efficiency, and succession planning
• Oversee eligibility and enrollment processes for members and dependents
• Serve as a subject matter expert on ERISA, CMS/MSP, HCRA, and CBA requirements
• Manage member appeals in partnership with General Counsel
• Oversee CMS Medicare Secondary Payer (MSP) Section 111 reporting and HCRA Covered Lives Assessments
• Lead administration and optimization of enterprise eligibility systems
• Partner with IT on system upgrades, data migrations, UAT, and regression testing
• Ensure data integrity across TPAs, PBMs, Medicare Advantage Plans, employer portals, and member portals
• Oversee eligibility audits, quality controls, remediation plans, and vendor reconciliation
• Present operational metrics and recommendations to executive leadership and Board Trustees
• Manage department budgets and identify opportunities for cost and process improvements

• Bachelor's degree in Business Management, Health Administration, or related field;
  Master's preferred
• 8+ years of senior-level Eligibility & Enrollment experience within health insurance or benefits
• 6+ years of supervisory/management experience leading large, diverse teams
• Strong knowledge of ERISA, CMS/MSP, and HCRA regulations
• Experience with Vitech-V3locity or a similar enterprise eligibility system strongly preferred
• Strong understanding of multi-employer benefits and Collective Bargaining Agreements
• Excellent analytical, organizational, communication, and leadership skills
• Ability to translate complex eligibility, regulatory, and operational data into actionable recommendations for senior leadership

This is a highly visible leadership position with the opportunity to shape eligibility operations, technology, compliance, and member service for a large-scale benefits organization. The role offers a strong compensation package and the potential for a hybrid schedule after an initial onsite period
.