Manager, Census & Member Services

Role Scope:

Our Health Plan is looking for a driven, detail oriented, self-starter to lead a team responsible for ensuring seamless continuity of insurance coverage for all PACE participants. This leader oversees daily operations, manages direct reports, and serves as the primary point of contact for complex insurance matters, including Medicare / Medicaid re-eligibility and end to end census management. The manager collaborates closely with the Growth / Enrollment team, the Interdisciplinary Team (IDT), and external partners such as Medicare, state Medicaid agencies, and contracted providers. This job opportunity is suited for an individual with a background in core health plan enrollment and eligibility processing operations, core claims and enrollment operations and / or other core health plan functions.

The role’s accountabilities will include:

• Lead day-to-day census, enrollment, eligibility, and Medicaid re-eligibility operations, ensuring all transactions are timely, accurate, and fully compliant.

• Develop, maintain, and enforce department policies, procedures, workflows, and monitoring routines, ensuring adherence by internal teams and external vendors.

• Produce and report operational metrics, audit findings, enrollment accuracy, and KPIs, identifying risks and driving timely remediation.

• Supervise, mentor, and develop staff while setting clear expectations and maintaining accountability for performance and quality.

• Serve as liaison with internal and external stakeholders to resolve escalated eligibility and enrollment discrepancies and ensure seamless coverage.

• Oversee membership maintenance across systems, including reconciliations, CMS interactions, and Medicare/Medicaid coordination of benefits.

• Own creation and maintenance of member correspondence and fulfillment materials in alignment with CMS guidance and plan policy.

• Identify and drive continuous improvement initiatives to enhance efficiency, accuracy, and participant experience.

Qualifications:

• 7+ years of experience in health insurance operations, including team leadership and direct supervisory experience.

• Demonstrated expertise in Medicaid and Medicare eligibility, with specific experience overseeing Medicaid re-eligibility processes.

• Background in capitated health plan financials; PACE experience strongly preferred.

• Strong customer service orientation and ability to handle confidential information.

• Excellent verbal and written communication skills.

• Bachelor’s degree in healthcare, finance, or related field required; Master’s degree preferred.

• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint).

Compensation:

We consider an individual’s qualifications, skillset, and experience in determining final salary. This role is eligible for health insurance, life insurance, participation in the company’s equity program, and paid time off, including vacation and sick leave. The expected salary range for this position is $100,000 - $123,000 and is bonus eligible. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location.

Vaccination Policy, including COVID-19

At Habitat Health, we aim to provide safe and high-quality care to our participants. To achieve this, please note that we have vaccination policies to keep both our team members and participants safe. For covid and flu, we require either proof of vaccination or declination form and required masking while in participant locations as a safe as an essential requirement of this role. Requests for reasonable accommodations due to an applicant’s disability or sincerely held religious beliefs will be considered and may be granted based upon review. We also require that team members adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment.

Our Commitment to Diversity, Equity, and Inclusion:

Habitat Health is an Equal Opportunity employer and is committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law.

Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law. Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at [email protected].

Beware of Scams and Fraud

Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/.

Contact Information:

If you are interested in this position, please contact [email protected] with “Habitat Health | Director, Accounting” and your name in the subject line. Please include a resume, and anything else that you feel will help us understand you and your interest in Habitat Health.

E- Verify Participation Notice:

This employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. If E-Verify cannot confirm that you are authorized to work, this employer is required to give you written instructions and an opportunity to contact Department of Homeland Security (DHS) or Social Security Administration (SSA) so you can begin to resolve the issue before the employer can take any action against you, including terminating your employment. Employers can only use E-Verify once you have accepted a job offer and completed the Form I-9.