Director of Eligibility Operations

Responsibilities Own the eligibility product roadmap, annual planning, and enhancement prioritization. Translate client and operational requirements into development-ready specifications. Own benefit-level configuration oversight and vendor integration strategy. Identify automation and AI‑assisted workflow opportunities within the eligibility function. Own the eligibility function's contribution to platform migration initiatives, including testing sign‑off, migration validation, and post‑go‑live stability. Keep the team's work visible to leadership through dashboards, reporting, or equivalent tools. Provide strategic oversight to the EDI/Eligibility Manager and maintain ultimate accountability for team performance and quality. Represent the eligibility function in client conversations and cross‑functional leadership discussions. Qualifications 10 or more years in healthcare eligibility, EDI operations, or PBM/health plan benefit administration. Expert knowledge of X12 834 and 270/271 transaction sets with hands‑on troubleshooting experience. Working SQL proficiency and familiarity with Snowflake or comparable cloud data platforms. Demonstrated experience owning or leading an eligibility or EDI function at a senior level. Experience managing operational continuity through active platform migrations or system transitions. Proven ability to lead through influence and own a product roadmap. Strong communicator across technical and non‑technical stakeholders, including clients and executives. Core Competencies Demonstrates extensive expertise in healthcare eligibility and EDI operations, with a strong focus on product roadmap ownership, strategic oversight, and cross‑functional leadership. Proficient in managing platform migrations and leveraging automation to enhance operational efficiency. Tools & Technologies SQL Snowflake Dashboards Reporting Tools #J-18808-Ljbffr Jobtailor