Meridian Health Plan

Director of Group Configuration & Enrollment

Meridian Health Plan$100K — $130K *
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's Degree (BS/BA) or equivalent required.
  • 10+ years of management experience in claims processing systems, ideally in healthcare.
  • Proven track record in ensuring data integrity and regulatory compliance.
  • Strong skills in presentation and communication with diverse stakeholders.
  • Expertise in budget development and policy management.

Responsibilities

  • Direct strategic operations for group, payment, and eligibility configuration.
  • Manage vendor relationships and performance for COBRA and HRA/Flex administration.
  • Monitor departmental workload and implement action plans to meet deadlines.
  • Oversee team efforts in 834 translation and client/vendor coordination.
  • Establish performance metrics and ensure alignment with company goals.
  • Document software upgrades impacting group setup and enrollment processes.
  • Lead cross-functional projects to support departmental and corporate objectives.

Benefits

  • Professional development opportunities to enhance industry expertise.
  • Comprehensive support for maintaining regulatory compliance.
  • Collaboration with cross-functional teams promoting diverse perspectives.
  • Opportunities for participating in company-wide initiatives and projects.
  • Flexibility to engage in travel as necessary for operational needs.
Full Job Description
Position: Director of Group Configuration and Enrollment

Reports To: Vice President of Operations

FLSA Status: Exempt

Summary:

The Director of Group, Payment & Enrollment Configuration, Cobra, and Flex/HRA is responsible for directing all operations within these teams reporting to the Vice President of Claims Operations. This role provides strategic and operational leadership for group, payment, and enrollment configuration, 834 set-up and testing, enrollment processing, and COBRA and Flex/HRA administration. Reporting to the Vice President of Claims Operations, this role is accountable for configuration accuracy, eligibility accuracy and data integrity, regulatory compliance, and operational performance.

Duties and Responsibilities (other duties may be assigned):

  • Provide leadership, strategic direction for group, payment, and eligibility configuration, eligibility processing, and eligibility quality assurance.
  • Coordinate, oversee, and manage vendor performance and relationship with external vendor (Alegeus) responsible for handling COBRA and HRA/Flex administration.
  • Monitor multiple departmental work/inventory levels and implement daily work/action plan to meet expected turnaround times.
  • Oversee team responsible for 834 translation, coordination, and testing and interaction with clients, brokers, and/or vendors.
  • Lead strategic staffing and capacity planning based on the volume of new and renewing groups, 834 implementations, manual eligibility transactions, QA needs, etc.
  • Oversee staff performance management, production standards, and quality outcomes across assigned teams and intervene with root cause analysis and corrective actions when goals are not being met.
  • Establish and monitor performance metrics, KPIs, and SLAs aligned with internal goals and client contractual commitments.
  • Overall responsibility for review and maintenance of department policies and procedures.
  • Partner with department management to identify team inefficiencies and determine solutions.
  • Partner with IT, Analytics, and external partners to improve data integrity, automation, and reporting capabilities that enhance departmental processes and performance.
  • Interact with and support other internal HPI departments with research, investigation, operational efficiencies, issue resolution, etc.
  • Documentation of all software upgrades and testing which impact group set-up and enrollment.
  • Provide guidance and instruction for staff members with respect to decisions and procedures within company systems to result in well-integrated processing and reporting output.
  • Represent department on company project teams as needed to achieve company objectives.
  • Lead cross-functional projects that support department and company goals.
  • Ability to travel to work locations as required.


Minimum Education Requirements (must have documented proof*):

  • Bachelor's Degree (BS/BA) or equivalent.


Minimum Experience Requirements:

  • Minimum of 10 years' management experience with claims processing system set up and claims operations, preferably in the healthcare industry


Preferred Education Requirements:

  • Bachelor's Degree (BS/BA) required.


Preferred Experience Requirements:

  • Ability to effectively present information and respond to questions from groups of executives, managers, providers and customers
  • Ability to anticipate and understand system interactions, integrations, and dependencies.
  • Ability to develop and manage budgets, policies and procedures that support the business.
  • Strong organizational, analytical, project management, and communications skills. Ability to respond to constantly changing circumstances and work under short deadlines.
  • Skilled in fostering teamwork and able to mentor/develop staff


Computer Skills:

  • Advanced skill level in Microsoft Office, including Word, Excel, Outlook and PowerPoint


About Meridian Health Plan

Meridian Health Plan Headquarters was a planned highrise in the Campus Martius district of downtown Detroit. The skyscraper would have had 16 stories with office space, ground level retail outlets, a state-of-the-art plaza, and a 9-story, 1,000 space parking deck. Detroit-based Meridian Health Plan would have been the sole office tenant in the 16-story building on the block bounded by Monroe, Bates and Farmer streets by Campus Martius Park. Meridian planned to occupy to 300,000 square feet of space in the $111 million development. Designs for the Class A building included first-floor retail space and a nine-story, 1,000-space parking deck. The brownfield incentives would be for site preparation and infrastructure improvements at the 1.96-acre site, a 230-space surface parking lot. Meridian, which has about 620 employees in two downtown offices in One Kennedy Square, 777 Woodward Ave., and the Dan Gilbert-owned 1001 Woodward building, would move into its new headquarters in early 2017, according to Sean Cotton, the company's general counsel. By that time, the company expects to have 1,050 employees in Detroit. Meridian initiated the new building project and hired Livonia-based Schostak Bros. as the developer. The site of the building is currently an oddly shaped, 230-space parking lot. Special architectural elements included a "floating box" like element, which is said to be the site of a restaurant. Other elements included a levitating belt of ivy, which will span from the 9-story parking deck, through the plaza, and to the side of the building. The main developer of the mid-rise was Schostak Bros. & Co. construction, which is located in the nearby suburb of Livonia.
Learn more about Meridian Health Plan
Size
501 employees
Market Cap
$1.3 billion
Industry
Founded
1960
5 Year Trend
+15.4%
NASDAQ

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