Director, Membership & Eligibility

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

Overview of the Role:

The Director, Membership & Eligibility is responsible for overseeing the daily operations of both the membership and eligibility teams. The Director will be responsible for managing the success of the performance of the team on ensuring business timelines are met. In addition, the Director will oversee the tracking and improvement of operational activities to ensure compliance metrics are met and setting up the team for continued success as we grow.

Responsibilities:

• Oversees performance and productivity standards specific systems in place to serve Alignment Health’s enrolled population.
• Responsible and accountable for mentoring, coaching, and training the Membership and Eligibility staff.
• Oversees overall performance of the Membership and Eligibility staff to ensure that all qualitative and quantitative goals and objectives are met within the department.
• Responsible for meeting the regulatory compliance in all areas that affect the department.
• Oversees the daily process of all membership regular and retro disenrollments. Report monthly the total disenrollments (both voluntary and mandated).
• Oversees the daily process of all regular and retro PCP transfers as completed by the Member Services Staff and report all changes monthly to Alignment Health’s subcontracted providers.
• Partners with Membership & Eligibility management team to create department policies and procedures as needed to ensure the department is in accordance with CMS guidelines.
• Assists in development and implementation of programs that directly affect the Membership & Eligibility team.
• Submits monthly reports to senior leadership.
• Works with DTS to create and implement systems to improve workflows, tracking, reporting, and maintenance of transportation within Internal database.
• Lead continuous improvement strategies to refine existing processes, ensuring a stellar member experience at every touchpoint.
• Performs other duties as assigned.

Supervisory Responsibilities:

Directly oversees department staff in respective units. Responsibilities include ensuring proper training of employees; planning, coaching, assigning, and directing work; assisting in the rewarding and disciplining of assigned employees; addressing complaints and resolving problems as they pertain to respective units.

Required Skills and Experiences:

• 8+ years management/leadership experience
• 5+ years in Health Maintenance Organization HMO or Medicare Advantage.
• Must have previous membership and eligibility experience.
• Bachelor’s degree or equivalent work experience in insurance or managed care preferably in a project management or quality improvement department.
• Strong sense of excellent customer service
• Must be familiar with CMS MMR and TRR files
• Must be familiar with EZCAP or similar system
• Must be familiar with MS Excel and MS Word
• Strong computer skills.
• Excellent communication skills.
• Excellent telephone techniques.
• Excellent data entry. Strong organizational skills.

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

• DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.