Senior Manager, Eligibility

Responsibilities

•    Lead, mentor, and manage the Business Intelligence Analysis Unit to ensure strong performance, effective workflows, and a high-quality operational structure.
•    Oversee daily, weekly, and monthly Business Intelligence (BI) operations to ensure analyses, reports, and deliverables are accurate, timely, and appropriately escalated.
•    Oversee and lead BI Unit testing activities for new system implementations and changes to existing applications; manage priorities, resolve technical issues impacting eligibility operations, and ensure testing results are documented and communicated.
•    Review eligibility nightly processes and control reports; analyze trends and variances, identify discrepancies, and direct corrective action in alignment with established policies and procedures.
•    Oversee development of Key Performance Indicator (KPI) and ad hoc reports, ensuring strong reporting methodology, efficient workflow, and effective internal controls.
•    Ensure data integrity for eligibility and enrollment datasets extracted via PostgreSQL, including hands-on data analysis, reconciliations, validations, and internal control reviews as needed.
•    Recommend and implement process improvements to enhance departmental efficiency and effectiveness.
•    Identify training needs, ensure cross-training, and foster a collaborative, high-performance team culture.
•    Perform hands-on analytical, reporting, and data validation work as needed to support unit operations and ensure continuity of critical processes.
•    Perform additional duties and special projects as assigned.

Qualifications

•    Bachelor’s degree in Health Information Technology, Healthcare Administration, Public Health, Computer Science, or equivalent experience required
•    Minimum six (6) years of healthcare data analysis and management experience, including experience supervising staff or leading project teams, and three (3) years of supervisory experience required 
•    Advanced proficiency in PostgreSQL, with demonstrated experience extracting, validating, and analyzing large eligibility and enrollment datasets
•    Advanced Microsoft Excel skills; working knowledge of Microsoft Word
•    Demonstrated experience leading UAT and system testing for new implementations and system changes, including test case development, issue tracking, and results analysis
•    Strong understanding of multi fund benefit plan structures, CMS requirements, and Medicare Advantage; Taft Hartley plan experience highly preferred
•    Exceptional organizational, analytical, and problem solving skills, with the ability to manage multiple priorities in a high volume environment
•    Strong leadership and communication skills, with the ability to present complex data clearly to stakeholders and guide staff performance