Manager, Eligibility & Enrollment

Location: Remote USA

Salary: $73,000–$114,000 per year

Company

hirify.global is a healthcare company founded in 2017 that combines an integrated care platform, advanced data and AI, and clinical and service experiences to improve the health and well-being of older Americans.

What you will do

• Manage daily workflows, queues, transaction inventory, aging, and backlog for Medicare Advantage enrollments, disenrollments, plan changes, cancellations, and retroactive adjustments.
• Monitor CMS MARx submissions, response and reply files, error reports, and monthly membership reconciliation.
• Resolve complex and exception-based cases and serve as the first escalation point for transaction and eligibility issues.
• Lead, coach, schedule, and develop Enrollment/Eligibility Associates while managing productivity, quality, engagement, and retention.
• Support CMS and internal audits, quality reviews, corrective action plans, regulatory updates, and operational procedure changes.
• Build monitoring and reporting views, improve processes, and partner on human-in-the-loop AI agents, system changes, UAT, and cross-functional issue resolution.

Requirements

• 4+ years of Medicare Advantage eligibility and enrollment operations experience, including at least 2 years in a supervisory or team lead role.
• Working knowledge of CMS enrollment and disenrollment regulations for HMO, PPO, and SNP products, including election periods, effective dating, and retroactive processing.
• Hands-on experience with CMS MARx processing, response and reply files, membership reconciliation, and audit support.
• Strong analytical, root-cause problem-solving, Excel, reporting, inventory tracking, trend analysis, and audit-sampling skills.
• Ability to work with operational tooling and AI-assisted processes under a human-in-the-loop model while protecting data accuracy and HIPAA confidentiality.
• Bachelor's degree in Business, Health Administration, or a related field, or equivalent education and directly relevant experience; availability for extended coverage during peak enrollment periods.

Nice to have

• Health plan, MSO, or TPA experience.
• Experience with QNXT, Facets, HealthEdge, HPMS, or similar health plan administration and CMS data exchange tools.
• Experience designing or overseeing AI agents in operational workflows.
• Master's degree such as an MBA or MHA.

Culture & Benefits

• Remote work with support for peak enrollment coverage.
• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off and a parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options, bonus eligibility for eligible roles, and a 401(k) program.