Director Of Eligibility

Job Description: Director of

Eligibility Overview: The Director of Eligibility oversees strategic and operational processes for member enrollment in health and welfare benefits. Lead a critical senior role ensuring compliance with regulatory frameworks and collective bargaining agreements. Manage enterprise eligibility systems, focusing on data integrity and system functionality. Collaborate with IT to administer Vitech-V3locity systems, ensuring seamless data migrations and upgrades. Ensure adherence to ERISA, CMS/MSP rules, and HCRA regulations in all operations. Drive strategic planning initiatives to meet organizational goals and improve performance standards. Foster a culture of transparency, ownership, and professional development within the team. Provide fiduciary oversight for compliance with DOL inquiries and legal document reviews. Director of

Eligibility Key Responsibilities & Duties: Lead and mentor management and line staff, focusing on accountability and succession planning. Oversee strategic planning and process improvement initiatives to exceed operational goals. Ensure compliance with ERISA, CMS/MSP, and HCRA regulations in eligibility operations. Administer enterprise eligibility systems, managing data migrations and system upgrades. Direct appeal processes in collaboration with General Counsel for timely determinations. Support functionality of employer and member portals for accurate data transmission. Provide administrative review of department budgets and implement expense controls. Oversee internal and external eligibility audits, developing remediation plans as needed. Director of

Eligibility Job Requirements: Bachelor's degree in Business Management, Health Administration, or related field required; master's degree preferred. Minimum 8 years of senior-level experience in healthcare eligibility and enrollment. Minimum 6 years of supervisory experience managing diverse teams. Extensive experience with Vitech-V3locity or similar enterprise eligibility systems. Deep expertise in ERISA, CMS/MSP rules, and HCRA regulations. Exceptional organizational, analytical, and communication skills. Proven ability to lead, mentor, and improve team performance. Experience presenting complex metrics to executives and board trustees.