Eligibility Operations Manager

Role Overview

The Eligibility Operations Manager serves as the bridge between partners’ business requirements and technical solutions. You will map member workflows and requirements to deliver a high-quality customer onboarding experience and ensure the solution aligns with partner business objectives.

Responsibilities

• Partner with cross-functional teams (Sales, Client Development, Member Outreach, Product, Engineering, Clinical Operations, Support, Revenue Cycle, Analytics) to ensure smooth partner onboarding
• Own client eligibility file setup, ongoing monitoring, and accuracy, including file processing and issue resolution
• Manage client QA processes to ensure accuracy and on-time launches
• Document client business requirements and act as a liaison between internal and external technical teams
• Lead client discussions on data integrations, configuration requirements, member workflows, and benefit design during pre-sales scoping and implementation
• Identify, escalate, and manage risks to successful implementation, delivery, and ongoing partnership; pivot to address bottlenecks quickly

Requirements

• 8+ years of experience in an analytics, implementation, client services, or operations role in a healthcare services or technology company
• Ability to lead matrixed internal and external teams through complex projects
• Comfortable adapting quickly in a dynamic environment and delivering results with minimal oversight
• Strategic problem-solving skills to proactively identify and resolve complex issues
• Knowledge of how health plans serve members across Medicare, Medicaid, and commercial lines of business

Nice-to-haves

• Strong customer-focused mindset and results orientation (implied by role fit values)