Remote Director, Enrollment Operations & Compliance

Remote Co.; United States; Remote; USD 113,000 - 198,000; Full time

Job summary

Remote Co. seeks a Director of Enrollment Operations to provide strategic and operational leadership for enterprise enrollment across product lines.

You will oversee end-to-end member enrollment, data integrity, platform integration, and vendor coordination with CMS, state MMIS, and external partners. The role requires experience with Medicaid/Medicare processes, system integrations, and a track record of leading teams and audits in healthcare operations.

Qualifications

• Bachelor's degree in accounting, finance, healthcare management or related field.
• MBA or related postgraduate degree preferred.
• Equivalent years of relevant work experience may be accepted in lieu of education.
• Seven years of leadership and management experience required.
• Five years of business operations experience, preferably in healthcare.
• Medicaid managed care, Medicare Advantage, Dual Special Needs Plan (D-SNP), or related healthcare experience required.

Responsibilities

• Lead end-to-end enrollment operations across markets, including lifecycle activities with SLA adherence.
• Oversee integration of enrollment operations for new or merging health plans; standardize processes.
• Establish enterprise enrollment oversight framework with dashboards and reconciliations.
• Drive enrollment strategy aligned with regulatory requirements and growth goals.
• Partner with IT on data governance, system enhancements, and integration strategies.
• Manage vendor relationships and enrollment partner SLAs; resolve exceptions.
• Lead automation, AI-enabled reconciliation, and process optimization initiatives.
• Monitor KPIs and regulatory compliance; address risks and gaps; report to leadership.
• Lead and develop enrollment operations teams; oversee audits and corrective actions.

Skills

Leadership

CMS regulations

Medicaid processes

Healthcare operations

System integrations

Data governance

Dashboards

Regulatory compliance

Vendor management

Auditing

Education

Bachelor's degree

MBA

Experience in lieu of degree

Tools

TriZetto EAM

Facets

MARx

HPMS

MMIS

Job description

Remote Co. seeks a Director of Enrollment Operations to provide strategic and operational leadership for enterprise enrollment across product lines.

You will oversee end-to-end member enrollment, data integrity, platform integration, and vendor coordination with CMS, state MMIS, and external partners. The role requires experience with Medicaid/Medicare processes, system integrations, and a track record of leading teams and audits in healthcare operations.