Director, Health Plan Enrollment & Eligibility

Role Scope: 

The Health Plan team is seeking a strategic, execution-oriented Director, Health Plan Enrollment & Eligibility to own end-to-end census integrity and member coverage continuity for all PACE participants. This leader is accountable for the design, performance, and scalability of enrollment and eligibility operations, including Medicare/Medicaid coordination and Medicaid re-eligibility. The Director leads a team responsible for day-to-day operations while also setting the roadmap for process maturity, risk controls, audit readiness, and cross-functional operating model alignment with Growth/Enrollment, IDT partners, and external agencies (CMS, state Medicaid agencies, and contracted partners). 

This role is suited for an experienced health plan operator with deep expertise in eligibility and enrollment operations who can translate regulatory requirements into durable workflows, define performance standards, and build an accountable and high performing team. 

The role’s accountabilities will include: 

• Set the vision and operating standards for census, enrollment, eligibility, and member services, translating regulatory requirements into scalable workflows and controls. 

• Provide oversight and accountability for day-to-day enrollment, eligibility, and Medicaid re-eligibility operations, ensuring accurate, timely, and compliant execution. 

• Establish and govern departmental policies, workflows, and operational controls to ensure consistent execution across internal teams and external partners. 

• Own operational performance management, including KPIs, audits, enrollment accuracy, and risk identification, and drive corrective actions through cross functional collaboration. 

• Lead and develop a high performing team responsible for enrollment, eligibility, and member maintenance, reinforcing accountability, quality, and professional growth. 

• Serve as a cross functional partner and escalation point to resolve complex enrollment and eligibility issues and ensure seamless member coverage. 

• Oversee membership maintenance, data integrity, CMS interactions, and member communications, while leading continuous improvement initiatives to enhance efficiency and participant experience. 

Qualifications:  

• 8+ years of experience in health insurance operations, including at least 2 years of team leadership and direct supervisory experience.  

• Demonstrated expertise in Medicaid and Medicare eligibility, with specific experience overseeing Medicaid re-eligibility processes.  

• Background in capitated health plan financials; PACE experience strongly preferred.  

• Strong customer service orientation and ability to handle confidential information.  

• Excellent verbal and written communication skills.  

• Bachelor’s degree in healthcare, finance, or related field required; Master’s degree preferred.  

• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint). 

Vaccination Policy, including COVID-19 

At Habitat Health, we aim to provide safe and high-quality care to our participants. To achieve this, please note that we have vaccination policies to keep both our team members and participants safe. For covid and flu, we require either proof of vaccination or declination form and required masking while in participant locations as a safe as an essential requirement of this role.  Requests for reasonable accommodations due to an applicant’s disability or sincerely held religious beliefs will be considered and may be granted based upon review. We also require that team members adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment.  

Compensation:  

We consider an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, participation in the company’s equity program, and paid time off, including vacation and sick leave. The expected salary range for this position is $130,000 to $165,000. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location. 

 Our Commitment to Diversity, Equity, and Inclusion: 

Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law. 

Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law.  Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at careers@habitathealth.com. 

Beware of Scams and Fraud 

Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/. 

Contact Information: 

If you are interested in this position, please contact careers@habitat.com with “Habitat Health | Director, Accounting” and your name in the subject line. Please include a resume, and anything else that you feel will help us understand you and your interest in Habitat Health. 

E- Verify Participation Notice:  

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9. 

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