Director of Eligibility Operations

Job Summary

Owning the eligibility function end to end, the full-time salaried Director of Eligibility Operations will manage product roadmaps, operational performance, and cross-functional coordination during a critical period of platform development and migration.

Key responsibilities

• Oversee the eligibility product roadmap, translating client requirements into development-ready specifications
• Lead the eligibility function's contribution to platform migration initiatives, ensuring operational stability post-go-live
• Provide strategic oversight to the eligibility team, partnering with cross-functional teams on escalations and initiatives

Required qualifications

• 10 or more years in healthcare eligibility, EDI operations, or PBM/health plan benefit administration
• Expert knowledge of X12 834 and 270/271 transaction sets with hands-on troubleshooting experience
• Working SQL proficiency and familiarity with Snowflake or comparable cloud data platforms
• Demonstrated experience leading an eligibility or EDI function at a senior level
• Experience managing operational continuity through platform migrations or system transitions