Supervisor, Eligibility

Job Summary 

 

The Supervisor of Eligibility oversees the Eligibility team, ensuring efficient and effective outreach to our members with an insurance barrier or a future barrier.  The role reports directly to the Director of Member Relations and Operations and is responsible for program and team development. The Supervisor assists the Director in the creation and execution of outreach strategies related to member eligibility, with the goal of member retention. The role involves supporting the Eligibility Specialists in day-to-day duties of providing direct outreach, education, and assistance to members to maintain or regain their referring insurance coverage. The Supervisor will lead, manage, and support the team as needed in retention efforts, including direct outreach to members to meet or maintain retention goals.  

 

Duties and Responsibilities 

 

• Define eligibility workflows, job aids, tools, technology, individual and team key performance indicators and reporting. 

• Develop and implement strategies to improve outreach effectiveness and member retention.  

• Evaluate team performance metrics, ensuring quality and efficiency are maintained.  

• Participate in the selection process, recommend candidates for hire, and oversee staff onboarding and training.  

• Lead, mentor, and motivate team members to achieve their individual goals and outcomes.  

• Collaborate across shared services and center functional areas to influence and create structure for the Eligibility program design and strategy. 

• Act as the primary point of contact for the market teams, sharing data and reporting and collecting feedback. 

• Address operational challenges promptly and implement effective solutions. 

• Serve at the eligibility program SME understanding caid/care processes and supporting team in navigating complex cases  

• Monitor implementation of changes to workflows and coach team members through the change. 

• Aggregate and analyze data and information using internal tools, surveys, and available data to gather insights and propose actionable process improvements or program development. 

• Evaluate adherence to Member Relations policy and procedures across all markets. 

• Draft and maintain up to date Member Relations policies and procedures, job aids, training content, and program descriptions. 

• Implement program structure in all local markets, working in collaboration with local market teams  

• Define and measure program outcomes, adjusting program strategy as needed to achieve organizational outcomes  

• Participate in the selection process and recommend candidates for hire. 

 

Minimum Qualifications 

• Associates degree required 

• Bachelor’s degree in healthcare administration, public health, or a related field preferred. 

• 2+ years with Medicaid, Medicare, and/or health plan coverage and eligibility requirements, e.g., state or federal Medicare/Medicaid agency or health plan eligibility experience 

• 1+ years’ experience in serving the needs of complex populations in a health care setting and working directly with members   

• 1+ years of experience in a supervisory or leadership role. 

• Good computer skills including Microsoft Office Suite (Outlook, Excel, PowerPoint, Word) and electronic medical record documentation required.   

• Excellent written and oral communication skills and the ability to work closely with co-workers, patients, family members, and State agencies. 

• Experience in Medicaid eligibility and application processes. 

• Experience and passion for working with and engaging vulnerable, hard to engage, co