Vice President, Enrollment and Eligibility

Vice President of Enrollment and Eligibility

The Vice President of Enrollment and Eligibility is responsible for providing strategic direction and management of the Enrollment and Eligibility Department. The VP will be a highly motivated leader with a demonstrated track record of success meeting or exceeding established objectives, leveraging a high performance team. The VP will be expected to ensure their department's adherence to all existing processes and procedures while also identifying areas for efficiency and enhancement. This requires the VP to oversee and monitor all performance related metrics, as well as identify additional metrics that are necessary to drive accuracy and efficiency. A detailed orientated person, the VP will be responsible to ensure that all enrollment and eligibility transactions and requirements meet or exceed established service level agreements. The VP will also be required to serve as the point of contact for external facing customers, as well as oversee a service team who will be the day to day point of contact to external clients whose eligibility the department is managing.

Primary Responsibilities

• Serve as the overall Subject Matter Expert within the company for the Enrollment and Eligibility responsibility.
• Establish department objectives that support company goals and produce regular status reports.
• Prepare an operating budget that reflects the forecasted needs of the department and control expenditures to assure adherence to approved budgets. Manage expenses not to exceed the budget
• Ensure effective workflows, maximize system efficiencies, monitor quality performance measures and confirm appropriate completion of work assignments. Make recommendations for change as appropriate.
• Implement checks and balances where appropriate to drive accuracy and timeliness of the Enrollment and Eligibility process.
• Ensure all Departmental deliverables and reporting requirements are met within the required timeframes.
• Partner with the technology Department to drive innovation and efficiency in the Enrollment and Eligibility process, delivering high satisfaction to our clients and their members.
• Approve personnel actions such as hiring, disciplinary, termination and/or salary recommendations.
• Participate in training, coaching and motivation of employees including career path development. Assess individual employee performance and conduct timely performance appraisals.
• Promote teamwork, discussion, and cooperation among staff and other departments. Ensure timely communication and sharing of information with team members.
• Work with staff to resolve work-related issues and concerns. Promote a respectful and diverse workplace.
• Develop and maintain departmental policies and procedures.

Minimum Education/Licensures/Qualifications

• 10+ years in health insurance industry.
• 5+ year's management experience.
• Bachelor's Degree in Business or Health Insurance Related Field.

Preferred Qualifications

• Master's in Business Administration or Health Insurance related field.
• Experience working with Taft Hartley trusts.
• Experience with self-funded insurance plan administration.
• Familiarity with ERISA rules and regulations.
• Experience overseeing Enrollment and Eligibility Responsibilities or a Plan or Self-Administered group.
• Preferred residence near Westbury, NY Office, but not required

About Brighton Health Plan Solutions, LLC

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you'll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you'll be encouraged to bring your authentic self to work with all of your unique abilities.

Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today's healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today's challenges into tomorrow's solutions.

Come be a part of the Brightest Ideas in Healthcare™.

Company Mission

Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners.

Company Vision

Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Brighton Health Plan Solutions in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All of our career opportunities are regularly published and updated brighonthps.com Careers section. If you have already provided your personal information, please report it to your local authorities. Any fraudulent activity should be reported to: View email address on click.appcast.io