Manager Membership & Enrollment - St. Luke's Health Plan - St. Luke's Health System

St. Luke's Health System in Boise, ID is seeking a Manager of Membership and Enrollment to join our Health Plan team.

The Manager of Membership and Enrollment is responsible for leading and managing the Membership and Enrollment department. This role is responsible for ensuring accurate and timely processing and reconciliation of member enrollments, disenrollments, and changes in coverage. The Manager is responsible for member and client premium billing, including addressing billing inquiries, resolving invoicing errors, managing delinquent accounts, and the administration of COBRA benefits. This role requires maintaining compliance with regulatory requirements, optimizing processes, and delivering exceptional customer service to St. Luke's Health Plan members.

• Oversee end to end membership and enrollment processes, ensuring efficiency, accuracy, and compliance with federal, state, and other regulations, including CMS guidelines for Medicare Advantage plans.
• Implement and monitor quality control and audit measures to ensure data integrity and accuracy in member information and enrollment transactions.
• Develop, create, and implement policies and procedures, workflows, and job aides to ensure compliance with regulatory standards, and provide training for the Membership and Enrollment Department.
• Act as the subject matter expert on the enrollment processes for all lines of business, including commercial, Administrative Services Only (ASO), Medicare Advantage. This includes group structure, premium billing, and coverage.
• Develop and coordinate necessary correspondence relating to enrollment, renewals, and disenrollment in accordance with applicable regulatory guidelines.
• Oversee COBRA administration and including compliance with COBRA regulations and timely processing of COBRA elections, notifications, and premiums payments.
• Partner with Finance to reconcile monthly payments and identify discrepancies requiring research and resolution.
• Coordinate with external partners, including Your Health Idaho (YHI), to communicate escalations, corrective action plans, and the development and implementation of tactical initiatives and processes to improve shared workflows.
• Collaborate with Customer Service teams to resolve member issues related to enrollment and coverage, ensuring a positive member experience and prompt resolution.
• Lead, mentor, and manage the Membership and Enrollment team, fostering a collaborative and high-performing work environment. Responsible for the planning, organizing and staffing; makes decisions on personnel actions (hiring, terminations, promotions, etc.); assigns personnel to projects and directs their activities; reviews and evaluates work and prepares performance reports.
• Performs other duties as assigned.

   

Minimum Qualifications:

Education: Bachelors degree or experience in lieu of degree

Experience: 6 years relevant experience

Licenses/Certifications: None

At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.