Director – Benefits & Eligibility Administration
Salary: $190,00 – $250,000 New York, NY | Senior Leadership Opportunity
We are seeking an experienced Director of Benefits & Eligibility Administration to lead the day-to-day operations of a large, complex healthcare benefits organization. This is a senior leadership opportunity for someone with a strong background in healthcare eligibility, enrollment, benefits administration, and team leadership. The Director will oversee a large operational team while ensuring accurate member enrollment, regulatory compliance, data integrity, and continuous improvement across the department.
Key Responsibilities
Leadership & Team Management:
Lead, mentor, and develop a large team of management and operational staff.
Establish performance expectations and promote accountability, professional development, and strong employee engagement.
Develop and implement strategies to improve departmental performance and operational efficiency.
Partner with senior leadership on departmental goals, priorities, and long-term planning.
Benefits & Eligibility Operations:
Oversee eligibility and enrollment processes for members, dependents, and spouses.
Ensure enrollment activities are accurate, timely, and consistent with benefit plan requirements and applicable agreements.
Develop and improve procedures, workflows, and operating standards.
Monitor department performance and identify opportunities to improve service and efficiency.
Regulatory & Compliance:
Provide leadership regarding healthcare benefits regulations and eligibility requirements.
Ensure departmental processes comply with applicable federal and state regulations.
Oversee member appeals and work with internal legal resources when necessary.
Support required regulatory reporting and compliance activities.
Monitor and address compliance issues through appropriate corrective action.
Data, Systems & Technology:
Oversee enterprise eligibility and enrollment systems and related operational processes.
Partner with technology teams on system enhancements, upgrades, testing, and data-related projects.
Ensure the accuracy and integrity of eligibility and enrollment data.
Oversee data exchanges with external partners, benefit administrators, and healthcare-related vendors.
Support employer and member-facing portals and ensure accurate processing of enrollment and eligibility information.
Financial & Quality Oversight:
Participate in departmental budget management and operational expense reviews.
Oversee internal and external audits related to eligibility and enrollment.
Analyze operational trends and develop corrective action and quality improvement plans.
Review vendor activity, billing, and reconciliations to ensure accuracy and contractual compliance.
Qualifications:
Bachelor's degree in Business Administration, Health Administration, or a related field required.
Master's degree preferred.8+ years of senior-level experience in healthcare eligibility, enrollment, benefits administration, or a related environment.6+ years of supervisory/management experience, preferably overseeing large and diverse teams.
Strong understanding of healthcare benefits administration, eligibility operations, and regulatory compliance.
Experience working with enterprise-level eligibility, enrollment, or benefits administration systems.
Strong analytical and data-management skills.
Demonstrated experience leading process improvement and operational initiatives.
Excellent communication, organizational, and leadership skills.
Ability to communicate complex operational information and performance metrics to senior leadership and other stakeholders.
Ideal Candidate:
The ideal candidate will be a proven healthcare benefits or eligibility leader who can manage a large team, navigate complex regulatory requirements, improve operational processes, and ensure a high level of accuracy across eligibility and enrollment functions. This is a high-level leadership position with significant responsibility, visibility, and opportunity to make an impact within a large benefits organization.
