Senior Manager, Health Plan Enrollment & Eligibility

Role Scope:

The Health Plan team is seeking a strategic, execution-oriented Senior Manager, 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 Senior Manager 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.

Core Responsibilities & Expectations for the Role

• Set the vision and operating standards for census, enrollment and eligibility, 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.

Required Qualifications:

• 6+ 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).

Compensation:

The anticipated base salary range for this position is $135,000-$155,000. This position is also eligible for a performance bonus of 10% of the base salary and may be eligible for additional incentive compensation, as applicable.

The final compensation offered will be determined based on factors including, but not limited to, the candidate's qualifications, skills, experience, education, certifications, geographical location, and business needs.

In addition, this position is eligible for a comprehensive benefits package, including medical, dental, and vision insurance; paid parental leave, short and long term disability coverage; life insurance; flexible spending accounts; a 401(k) savings plan that includes a match; paid time off; and company paid holidays.

Vaccination Policy, including COVID-19

To help maintain a safe environment for our participants and team members, Habitat Health maintains vaccination and infection control policies applicable to certain roles and work locations. For COVID-19 and influenza, team members are required to provide either proof of vaccination or a signed declination form and comply with applicable masking requirements while working in participant care settings.

Habitat Health will consider requests for reasonable accommodation based on an applicant's disability, medical condition, or sincerely held religious belief, practice, or observance in accordance with applicable law.

As a condition of employment, team members are expected to comply with all applicable infection control protocols, personal protective equipment (PPE) requirements, and vaccination requirements associated with their role, work location, and regulatory obligations.

At-Will Employment

Employment with Habitat Health is at-will. This means that either the employee or the employer may terminate the employment relationship at any time, with or without cause, and with or without notice, subject to applicable law. Nothing in this job posting or any other company document is intended to create a contract of employment, express or implied, or to alter the at-will nature of employment.

Any written or oral statements to the contrary are not authorized unless made in writing and signed by an authorized representative of the Company.

Because this is a remote position, employment will be governed by the laws applicable to the employee’s work location, and applicable legal requirements will be followed.