Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
A Little More About The role:
Director of Enrollment & Eligibility is accountable for the end-to-end eligibility and enrollment function at Gravie. This role ensures accurate member eligibility, timely and compliant enrollments, and seamless data flow to claims, billing, stop-loss, and vendor partners. Eligibility accuracy is foundational and this leader plays a critical role in minimizing claims risk, payment errors, member disruption, and client escalations.
You will:
· Own all eligibility and enrollment operations for employer groups administered by Gravie, including onboarding, open enrollment, life event changes, terminations, COBRA transitions, and ongoing eligibility maintenance.
· Ensure accurate and timely eligibility setup and updates to support downstream claims adjudication, billing, stop-loss reporting, and vendor feeds.
· Establish operational standards, SLAs, and controls to ensure eligibility accuracy across all level-funded plan designs.
· Serve as the escalation point for complex eligibility issues impacting claims payment or member access to care.
· Own eligibility data governance, ensuring consistency across enrollment platforms, claims systems, billing, and external vendors.
· Partner with Configuration, Product and Technology to define eligibility configuration standards, file feeds, and system enhancements.
· Lead testing, validation, and go-live readiness for new groups, plan years, and system changes.
· Drive automation and reduction of manual work to improve speed, accuracy, and scalability.
· Partner closely with Claims Operations to ensure eligibility rules and effective dates support accurate claims adjudication.
· Collaborate with Accounting and Finance to ensure eligibility aligns to premium billing.
· Monitor and mitigate eligibility-related financial risk, including retroactivity, late adds, and termination timing issues.
· Support reconciliation efforts and root cause analysis for eligibility-driven claims or billing discrepancies.
· Ensure eligibility and enrollment processes comply with all regulations and contractual client requirements.
· Create and maintain a balanced scorecard of cost, quality and time metrics with goals, including implementation, enrollment, eligibility updates, billing and escalation handling.
· Maintain audit-ready documentation, controls, and reporting.
· Support internal and external audits, client reviews, and regulatory inquiries related to eligibility and enrollment.
· Partner with Legal and Compliance on policy development and risk mitigation.
· Partner with Account Management and Implementation teams to deliver a high-quality employer and member onboarding experience.
· Lead and develop a high-performing eligibility and enrollment team, including managers and individual contributors.
· Define clear roles, workflows, and performance metrics aligned to accuracy, timeliness, and service quality.
· Build training programs and documentation to support consistency and scalability.
· Foster a culture of accountability, ownership, and continuous improvement.
You bring:
· 8+ years of experience in eligibility and enrollment within a TPA, health plan, or benefits administration environment
· 5+ years of people leadership experience, including leading managers
· Deep understanding of eligibility administration and its impact on claims, billing, and funding
· Experience working with enrollment systems, eligibility files, and claims platforms
· Strong operational, analytical, and process design capabilities
Extra credit:
· Experience supporting Commercial level-funded plans
· Familiarity with stop-loss reporting and carrier/vendor integrations
· Experience partnering with Product and Engineering teams in a TPA environment
· Exposure to automation, workflow tools, and eligibility data architecture
Gravie:
In order to transform health insurance and build a health plan everyone can love, we need talented people doing amazing work. In exchange, we offer a great overall employee experience with opportunities for career growth, meaningful mission-driven work, and an above average total rewards package.
The salary range for this position is $121,275 - $202,125 annually. Numerous factors including, but not limited to, educations, skills, work experience, certifications, etc. will be considered when determining compensation. In addition to base salary, this position is also eligible to participate in Gravie’s annual bonus program. Stock options may also be awarded as part of the compensation package.
Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, Gravie’s package includes alternative medicine coverage, generous PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and paid paw-ternity leave.
A Little More About Us:
At Gravie, we're on a mission to reinvent health benefits for small and midsize businesses—making high-quality, affordable healthcare accessible to employers and their employees. We believe better benefits lead to better lives, and we’re building the future of health benefits to reflect just that.
We’re proud to be the only company offering both innovative level-funded health plans and a market-leading ICHRA solution, giving employers more choice and flexibility than ever before.
And guess what? Our customers love us. With member and employer satisfaction rates consistently trending above 80%, we know our health plans are working the way they should. Backed by some of the most sought-after investors in the country, we have the resources and long-term support to build something truly transformative—and we’re just getting started.
At Gravie, we do things differently. We’ll challenge you, and we’ll welcome you challenging us. Good ideas are everyone's job here. You’ll join a team that’s smart, mission-driven, and unafraid to push boundaries if it means making a bigger impact for the people we serve.
If you're energized by a high-performance, high-trust environment where your voice matters, Gravie might be just the place for you.
