Director, Enrollment & Billing Operations

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The Director of Enrollment and Billing is responsible for providing strategic direction and operational oversight for the eligibility and enrollment of fully insured groups and individual lines of business.

POSITION PURPOSE :

The Enrollment and Billing Director is responsible for providing strategic direction and operational oversight for the eligibility and enrollment of groups and/or individual members within their assigned customer segment. Responsible for ensuring the successful execution of billing, premium collection, cancelation, reconciliation and other enrollment and eligibility related operations. Directs assigned staff and is responsible for driving effective and efficient operational processes and procedures based on industry standard internal and external metrics.

Accountable for complying with all laws and regulations associated with duties and responsibilities.

NATURE AND SCOPE :

This position reports to Vice President, Enrollment and Billing.

ACTIVITIES OF DIRECT REPORTS:

This position has the following direct reports noted below as well as approximately 100 indirect reports in membership and billing area.

Direct Reports:

Manager(s), within Assigned Areas of Responsibility

Senior Level staff that provide support across assigned areas and/or external business areas

NECESSARY CONTACTS:

In order to effectively fulfill this position the incumbent must be in contact with:

Regional Directors, District Office Personnel, Sales Representatives, Area offices, Marketing, Underwriting, Corporate Compliance, Customer Service, Business Engineering team, Plan Performance, Information Technology, Claims, Coding Units, Legal, Contract Compliance , Finance, and other departments in BCBSLA as needed.

All levels of organizational leadership from front line staff and up through the organization’s Senior Management Team

External contact may include; Subscribers, other Blue Cross Blue Shield Plans, Consultants, Agents, Brokers, Group Leaders and vendors.

QUALIFICATIONS :

A college degree is required. Four years of related work experience can be used in lieu of degree.

Master’s degree is preferred. Continuing education within the insurance and/or healthcare industry is preferred.

A minimum of 7 years managing direct customer support operations is required. Experience with membership related duties inclusive of enrollment, billings and reconciliations preferred.

A minimum of 3 years experience managing people and demonstrated leadership skills.

Experience in the healthcare industry operations is preferred, particularly within the health insurance sector.

Experience with identifying, implementing, monitoring and managing business area operational and financial controls as required.

Working knowledge of operations related application software and demonstrated ability to use available technology to develop and improve operational process and practices.

Strong analytical, communication, and leadership skills are required.

ACCOUNTABILITIES :

Directs the department operations and staff to ensure timely and accurate enrollment, billing, and processing of new and renewing health plan customers, annual budget planning and management, and operational compliance. Actively mentors and coaches department team members.

Reviews and monitors the effectiveness of the departmental procedures and practices to proactively manage and improve member enrollment and premium billing for all BCBSLA individual and/or group customers.

Develops highly collaborative working relationships with key organizational support areas (e.g. HR, IT, Audit, Project Management, and Finance) and process dependent operational areas to jointly develop or adjust procedures and/or practices that require coordination and handoffs with partner operational areas (Underwriting, Marketing, Claims, Customer Service, etc.) related to rate increases, benefit changes, new products, operational transactions, and special billing situations.

Provides oversight and directs delinquency resolution activities of collection and reinstatement to ensure operational practices are compliant with applicable regulatory requirements and company policies.

Formulates and administers departmental policies.

Develops departmental goals and objectives that ensure accurate and efficient operations are in place to serve our customers and practices remain compliant with corporate policies.

Ensures fundamentally sound operational controls are in place, monitored, and managed to pass internal and external audit reviews and annual control reviews associated with annual corporate audits (e.g.SOC1, Model Audit Rule (MAR), etc.)

Establishes relevant operational metrics and monitors work performance to ensure required divisional, Association, other applicable performance standards and applicable Service Level Agreements (SLAs) are met or exceeded. Monitors and manages third party performance measures to ensure compliance and timely corrections when out of compliance with agreed upon service levels.

Job Duties are performed in a normal and clean office environment with normal noise levels.

Work is predominately done while sitting or standing.

The ability to comprehend, document, and analyze is required.

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An Equal Opportunity Employer

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