Dir, Configuration, Implementation, Eligibility and Billing

Director, Configuration, Implementation, Eligibility & Billing

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

Hybrid

SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2025 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Summary:

Leads the strategy and execution of enrollment, premium billing, client implementation, and system configuration. Ensures the accurate setup of new groups, benefits, and provider pricing, creating a seamless experience for both members and clients.

Oversees product readiness, ensures all offerings are fully prepared and compliant for market launch, and collaborates with cross-functional teams to streamline operations and enhance efficiency. Drives continuous improvement in healthcare insurance systems while maintaining strict compliance with industry regulations.

Optimizes service delivery and ensures customer satisfaction utilizing strong leadership skills, deep expertise in healthcare insurance operations, and a commitment to delivering exceptional outcomes.

Formal Education Required:

a. Bachelor's degree or equivalent combination of education and/or experience

Experience and Training Required:

a. Five (5) years experience which includes claims, configuration, project management, eligibility administration, and/or implementation experience in a healthcare environment, to include:

b. Five (5) years direct supervision of staff

c. PMP, LSS Green Belt, CPC certifications are preferred

3. Other Skills, Competencies and Qualifications:

a. Working knowledge and proficiency with Microsoft Office - Word, Excel, Visio at an intermediate level

b. Working knowledge and proficiency with Amisys Advance, HealthEdge Source, Wipro, Softheon, HPMS systems

c. Working knowledge and proficiency with Microsoft SQL preferred

d. Possess proven leadership and management expertise and demonstrated ability to lead, mentor, and inspire cross-functional teams, driving performance and achieving organizational goals through effective leadership and management practices.

e. Technical proficiency and expertise in utilizing applications above with the ability to leverage these tools to optimize workflow, streamline processes, and enhance team collaboration.

f. Possess critical thinking and problem-solving skill with strong ability to apply logical and strategic thinking to analyze complex challenges, gather relevant data, and develop actionable insights that lead to well-informed decisions.

g. Possess project management expertise with proven experience in leading and managing projects from inception to completion, with a working knowledge of Agile and Scrum methodologies to drive project efficiency, ensure timely delivery, and adapt to changing business needs.

h. Possess excellent analytical skill and strong orientation to detail. Exceptional analytical skills with a keen eye for detail, ensuring that all data and processes are meticulously examined for accuracy, compliance, and continuous improvement.

i. Ability to be a collaborative team player. Proven ability to work effectively in a team-oriented environment, building strong relationships with colleagues and stakeholders to achieve collective objectives and drive business success.

j. Possess exceptional time management and ability to multitask. Highly skilled in organizing, prioritizing, and executing tasks within tight deadlines, thriving in fast-paced environments and consistently meeting project timelines.

k. Possess working knowledge of industry regulations and compliance. In-depth understanding of healthcare regulations and company policies, with a commitment to maintaining compliance and staying current on industry standards and regulatory changes.

l. Ability to maintain confidentiality and integrity. Strong commitment to safeguarding sensitive health and business information, adhering to confidentiality standards and ethical practices in all interactions.

m. Ability to be adaptable and flexible. Agile and adaptable with the ability to adjust work hours and schedules as necessary to meet evolving business needs and organizational priorities.

n. Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity

4. Level of Physical Demands:

a. Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.

Equal Opportunity Employer/Veterans/Disabled

$49.29/hr - $73.94/hr

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.

Basic Life and Accidental Death & Dismemberment (AD&D)

Supplemental Life and AD&D

Dependent Life Insurance

Short-Term and Long-Term Disability

Accident Insurance, Hospital Indemnity, and Critical Illness

Retirement Savings Plan

Flexible Spending Accounts - Healthcare and Dependent Care

Employee Assistance Program (EAP)

Identity Theft Protection

Pet Insurance

Education Assistance

Daily Pay