Director of Benefits and Eligibility Administration

Job Description

Director – Benefits & Eligibility Administration

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Salary: $190,00 – $250,000

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New York, NY | Senior Leadership Opportunity

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We are seeking an experienced Director of Benefits & Eligibility Administration to lead the day-to-day operations of a large, complex healthcare benefits organization.

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This is a senior leadership opportunity for someone with a strong background in healthcare eligibility, enrollment, benefits administration, and team leadership . The Director will oversee a large operational team while ensuring accurate member enrollment, regulatory compliance, data integrity, and continuous improvement across the department.

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Key Responsibilities

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Leadership & Team Management

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• Lead, mentor, and develop a large team of management and operational staff.
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• Establish performance expectations and promote accountability, professional development, and strong employee engagement.
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• Develop and implement strategies to improve departmental performance and operational efficiency.
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• Partner with senior leadership on departmental goals, priorities, and long-term planning.
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Benefits & Eligibility Operations

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• Oversee eligibility and enrollment processes for members, dependents, and spouses.
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• Ensure enrollment activities are accurate, timely, and consistent with benefit plan requirements and applicable agreements.
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• Develop and improve procedures, workflows, and operating standards.
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• Monitor department performance and identify opportunities to improve service and efficiency.
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Regulatory & Compliance

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• Provide leadership regarding healthcare benefits regulations and eligibility requirements.
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• Ensure departmental processes comply with applicable federal and state regulations.
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• Oversee member appeals and work with internal legal resources when necessary.
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• Support required regulatory reporting and compliance activities.
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• Monitor and address compliance issues through appropriate corrective action.
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Data, Systems & Technology

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• Oversee enterprise eligibility and enrollment systems and related operational processes.
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• Partner with technology teams on system enhancements, upgrades, testing, and data-related projects.
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• Ensure the accuracy and integrity of eligibility and enrollment data.
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• Oversee data exchanges with external partners, benefit administrators, and healthcare-related vendors.
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• Support employer and member-facing portals and ensure accurate processing of enrollment and eligibility information.
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Financial & Quality Oversight

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• Participate in departmental budget management and operational expense reviews.
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• Oversee internal and external audits related to eligibility and enrollment.
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• Analyze operational trends and develop corrective action and quality improvement plans.
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• Review vendor activity, billing, and reconciliations to ensure accuracy and contractual compliance.
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Qualifications

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• Bachelor's degree in Business Administration, Health Administration, or a related field required.
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• Master's degree preferred.
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• 8+ years of senior-level experience in healthcare eligibility, enrollment, benefits administration, or a related environment.
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• 6+ years of supervisory/management experience , preferably overseeing large and diverse teams.
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• Strong understanding of healthcare benefits administration, eligibility operations, and regulatory compliance.
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• Experience working with enterprise-level eligibility, enrollment, or benefits administration systems .
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• Strong analytical and data-management skills.
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• Demonstrated experience leading process improvement and operational initiatives.
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• Excellent communication, organizational, and leadership skills.
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• Ability to communicate complex operational information and performance metrics to senior leadership and other stakeholders.
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Ideal Candidate

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The ideal candidate will be a proven healthcare benefits or eligibility leader who can manage a large team, navigate complex regulatory requirements, improve operational processes, and ensure a high level of accuracy across eligibility and enrollment functions.

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This is a high-level leadership position with significant responsibility, visibility, and opportunity to make an impact within a large benefits organization.