Gravie · 11 hours ago
Director of Enrollment and Eligibility
United States
Full-time
Remote
Senior Level, Lead/Staff
$121K/yr - $202K/yr
8+ years expGravie is on a mission to improve healthcare access through innovative health benefit solutions. The Director of Enrollment & Eligibility is responsible for overseeing the eligibility and enrollment functions, ensuring accuracy and compliance, and leading a high-performing team to enhance operational efficiency.
Employee BenefitsHealth CareInsuranceInsurTech
Responsibilities
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
Qualification
Required
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
Preferred
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
Benefits
Alternative medicine coverage
Generous PTO
Up to 16 weeks paid parental leave
Paid holidays
A 401k program
Transportation perks
Education reimbursement
Paid paw-ternity leave
Company
Gravie
Gravie is an insurance company that designs health benefits plans for small and midsize employers.
201-500 employees
Funding
Current Stage
Late StageTotal Funding
$532.62MKey Investors
Trinity CapitalGeneral AtlanticGeorgian
2025-06-01Private Equity· $150M
2024-06-25Debt Financing· $40M
2023-03-21Private Equity· $179M
Leadership Team
Charles Marentette
CFO
Amy Spartz
Chief People Officer
Recent News
2025-08-08
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Company data provided by crunchbase