Senior Manager, Enrollment Operations

Job Summary:

The Senior Manager, Enrollment Operations will oversee the daily operations of member enrollment processes, ensuring efficient execution and monitoring of enrollment activities. This role will focus on coaching and developing the team while maintaining high standards of accuracy and compliance in enrollment operations.

Essential Functions:

• Oversee the day-to-day activities of the enrollment team, ensuring timely and accurate processing of member enrollment, including ID card production and distribution of new member welcome kits.
• Track and analyze key performance indicators related to member enrollment, including processing timelines, accuracy, and member feedback to identify areas for improvement.
• Provide leadership, training, and mentorship to enrollment professionals, promoting high performance and continuous improvement within the team.
• Address complex enrollment challenges, ensuring member concerns are handled efficiently and accurately. Lead resolution efforts when discrepancies arise in enrollment data or when enrollment files are rejected or delayed.
• Work closely with other departments to resolve enrollment issues, improve systems, and ensure smooth transitions for new members.
• Maintain compliance with relevant regulations, including Medicaid, Marketplace, and Dual coverage requirements under HIPAA and other federal/state guidelines.
• Identify operational inefficiencies and lead initiatives to streamline and automate enrollment processes to enhance speed, accuracy, and member satisfaction.
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in Computer Science, Information Systems, Business Administration, Healthcare Management, or a related field, or equivalent years of relevant work experience
• Seven (7) years of experience in member enrollment operations, with significant exposure to Medicaid, and Dual coverage products is required
• Three (3) years of experience leading teams and managing cross-functional projects in a health insurance or managed care environment is required

Competencies, Knowledge, and Skills:

• Proficient in managing the end-to-end enrollment process, including ID card production and onboarding.
• In-depth knowledge of Medicaid, and Dual coverage programs, including unique enrollment requirements and regulatory compliance.
• Strong understanding of HIPAA 834, EDI 270/271, DTRR, MMR, and other industry-standard enrollment files and data exchange processes.
• Excellent leadership skills with experience in managing and mentoring an enrollment team.
• Ability to manage operational workflows and drive improvements to increase accuracy and efficiency in enrollment processes.
• Advanced knowledge of healthcare enrollment systems and related software tools.
• Familiarity with data transmission protocols and enrollment file management tools (EDI, FTP, etc.) and the ability to troubleshoot technical issues.
• Strong attention to detail to ensure accuracy and compliance with regulations.
• Excellent written and verbal communication skills.
• Strong customer service mindset, ensuring a smooth and positive experience for new members during the enrollment process.
• Strong project management skills with experience managing cross-functional projects and meeting tight deadlines.

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods
• Occasional travel may be required

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business