Enrollment Manager

at  State of Washington Health Benefits Exchange

DESCRIPTION

The mission of Washington Health Benefit Exchange (Exchange) is to radically improve how Washington residents secure health insurance through innovative and practical solutions, an easy-to-use customer experience, our values of integrity, respect, equity and transparency, and by providing undeniable value to the health care community.
The Exchange is a public-private partnership that operates Washington Healthplanfinder, the eligibility and enrollment portal used by one in four Washington residents to obtain health and dental coverage. Through this platform, and with support from a Customer Support Center and statewide network of in-person navigators and brokers, individuals and families can shop, compare and enroll in private, qualified health plans (as defined in the Affordable Care Act) or enroll in Washington Apple Health, the state Medicaid program.
The Exchange embraces the following equity statement adopted by our Board of Directors:
Equity is fundamental to the mission of the Washington Health Benefit Exchange. The process of advancing toward equity and becoming anti-racist is disruptive and demands vigilance to dismantle deeply entrenched systems of privilege and oppression. While systemic racism is a root cause of many societal inequities, we must also use an intersectional approach to address all forms of bias and oppression, which interact with and often exacerbate racial inequities. To be successful, we must recognize the socioeconomic drivers of health and focus on people and places where needs are greatest. As we listen to community, we must hold ourselves accountable to responding to recommendations to remedy inequitable policies, systems, or practices within the Exchange’s area of influence. Our goal is that all Washingtonians have full and equal access to opportunities, power and resources to achieve their full potential.

SUMMARY

The Enrollment Manager is responsible for leading and managing all enrollment functional and operational activities, and the supervisors and staff that carry out enrollment operations. This position serves as the subject matter expert on federal and state regulations, including the Affordable Care Act, that govern enrollment standards for programs including Qualified Health and Dental Plans, Health Insurance Premium Tax Credits, Cost Sharing Reductions, Cascade Care Savings, and Special Enrollment.
The Enrollment Manager provides oversight to ensure all reconciliation, payment, and escalation resolution activities are performed accurately and timely. This includes providing guidance to staff on complex enrollment issues, evaluating operational processes for improvement, and ensuring information is provided to internal teams, carriers, customers, and external stakeholders. This position will also develop and maintain business requirements, processes, and written guidance related to the reconciliation of enrollment and payment data with carriers.
The Enrollment Manager oversees resolution of high-profile cases, including referrals from the Office of the Insurance Commissioner (OIC) the Governor’s office, and legislative staff; and works with management, executive teams, and external partners and agencies as needed. In addition, the Enrollment Manager serves as an escalation point for staff and is responsible for elevating cases or issues as needed to manage risk to the organization. This position provides guidance and makes decisions regarding best course of action toward individual application issue resolution and will partner with key members of the operations department’s management team, colleagues in other departments, executive leaders, as well as IT and the system integrator regarding issues impacting multiple applications.

QUALIFICATIONS

Required:

• Five years of progressively increasing leadership responsibility and experience in business or other healthcare operations..
• Two years of experience managing people and teams.
• Broad knowledge and understanding of the health care industry, including the commercial insurance market, Medicaid, or other health delivery systems.
• Motivated self-starter with initiative to take independent action and accept responsibility for your actions.
• Demonstrated experience in problem-solving, making recommendations for key business decisions, and guiding or directing stakeholders or business partners to successfully perform their duties in a business relationship or marketplace.
• Well organized, flexible, proactive, resourceful, and efficient with strong attention to detail.

Ability to collaborate and work effectively within a complex organization with a large technology deployment and related vendors to drive operational excellence.

• Experience building relationships with customers and partners.
• Must be a strategic thinker.
• Strong interpersonal skills: ability to work with diverse client populations, vendors, carriers, as well as all levels of internal management and staff.
• Ability to prioritize and manage multiple projects simultaneously and follow through on issues in a timely manner.
• Strong verbal and written communication skills.
• Must be a team player with a positive can-do attitude.
• Must be able to facilitate discussions with core stakeholders including both small and large audiences
• Proficiency in Microsoft Office Suite, especially Excel and PowerPoint.

Desired:

• Experience with leading or managing health insurance enrollment and eligibility programs, rules, policies, and regulations in a state or commercial insurance market
• Thorough knowledge and understanding of the health insurance components in the Affordable Care Act (ACA), especially health insurance exchanges.
• Understanding of the federal rule-making process and interpretation of federal guidance
• Demonstrated experience working in a business-to-business relationship and problem-solving with multiple business partners, diverse stakeholder management, including facilitation of multiple stakeholders towards consensus or common understanding (if not agreement), preparing, and making presentations, and otherwise engaging key partners and stakeholders.
• Bachelor’s degree in business or a health policy-related field.
• Experience in the government field.

SPECIAL REQUIREMENTS

A criminal background screen will be conducted for candidates under final consideration, and if hired, every five years of employment where highly sensitive data is processed or maintained by the position. The result of this background screen must meet the Exchange’s eligibility standards.

OTHER INFORMATION

The above statements are intended to describe the general nature and levels of work being performed. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills of personnel so classified.
This is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
The Washington Health Benefit Exchange is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, marital status, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We participate in E-Verify (Download PDF reader). You can view the Department of Justice’s Right to Work poster here (Download PDF reader).

DUTIES AND RESPONSIBILITIES

Program Oversight/Leadership

• Provide direct oversight and leadership to the Enrollment Team, combining all enrollment operational duties under their purview.
• Directly supervise Enrollment Supervisors and Senior Enrollment Solutions Analyst .Provide 2nd level leadership support for staff reporting directly to these Supervisors. Oversee caseloads, project assignments and team resources as needed. Effectively maintain staffing needed to support assigned business functions by overseeing recruiting, selecting, orienting and training and developing growth opportunities. Recruit talented individuals and support their development for retention and success.
• Set strategic direction, goals, and metrics and implement processes to optimize customer experience and ensure accurate reconciliation of enrollment data with insurance carriers.
• Maintain a safe and healthy work environment by establishing and applying standards and fostering collaborative teamwork. Work closely with and advise the Associate Director for Operations, Eligibility, and Enrollment; the Operations Management Team; and Executive Leadership and provide information and recommendations to assist with their decisions concerning enrollment and other related topics. Also partner closely with the Carrier Operations Manager, Compliance Team, and other leaders as needed to ensure carriers process enrollment data timely and accurately, and to drive improvements in the customer enrollment journey
• Model commitment to Equity, Diversity, and Inclusion and foster a team environment that operates in alignment with WAHBE values of integrity, respect, equity, and transparency. Apply a DEI lens to all areas of work, including leading the team, engaging with colleagues, and interfacing with external partners, including but not limited to insurance carriers, the Office of the Insurance Commissioner, and the Health Care Authority.

Manage Program Integrity & Lead Complex Issue Analysis and Resolution

• Oversee timely and equitable resolution of customer enrollment and reconciliation issues and complaints in a manner consistent with regulatory requirements and organizational values. Provide guidance when needed to supervisors and staff regarding customer concerns that are escalated from constituents and stakeholders.
• Coordinate with all areas within the Exchange that are touch points for customer service to implement process improvements.
• Consult the Compliance Officer and Chief Strategist/General Counsel as needed on complex issues as well as to review proposed changes and continuous improvements to enrollment and reconciliation processes and procedures.
• Serve as Chair to the Review Board and serve as the representative to the Special Operations Review Team.
• Collaborate cross-departmentally to prioritize defect resolution and data fixes to ensure swift resolution of issues that impact WAHBE customers.
• Represent Enrollment in the Agile process: make programmatic decisions regarding system enhancements, provide business requirements, and inform design, prioritization, and implementation of changes in Healthplanfinder systems.
• Collaborate to define business requirements for reconciling enrollment and payment data with carriers and work with WAHBE technical teams on design and implementation of EDI software solutions.
• Ensure relevant updates to policies, procedures, and processes are documented in the Carrier Enrollment and Payment Process Guide, and that updates align with other guidance across the organization. Communicates these updates to all stakeholders.
• Serve as an organizational expert on the enrollment and reconciliation functions of the Healthplanfinder system. Track, monitor and elevate issues that are identified with the application process, and potential defects within the Healthplanfinder system that have a direct impact on the customer experience.
• Oversee development, training, and mentoring of team on new and existing processes, procedures, and guidelines. Performs these activities directly as applicable.
• Maintain confidential client records, statistical data, and tracking information; provide reporting information to WAHBE Executive Leadership and the Board of Directors.