Working Title: Marketplace Eligibility & Enrollment Director
Agency: Department of Insurance
Closing Date/Time: 09/12/2024
Salary: $10,167-$12,167 monthly
Job Type: Salaried /Full Time
County: Cook
Number of Vacancies: 1
Plan/BU: None
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Position OverviewAs the Director of eligibility and enrollment activities at Get Covered Illinois (GCI), this role offers a unique opportunity to be at the forefront of the State Based Marketplace initiative. You'll be instrumental in shaping GCI's response to changes in state and federal healthcare laws and regulations, developing agency policy related to Affordable Care Act programs, and managing the administration of significant federal advanced premium tax credits. Additionally, your influence and guidance will be crucial in steering the strategic and tactical direction of the agency, aligning actions with long-term goals and the mission of GCI. Collaboration will be a key aspect of this role, as you'll be responsible for fostering partnerships and program integration between GCI and various state agencies, including the Departments of Healthcare & Family Services, Human Services, the Governor's Office, and DoIT. Your ability to navigate these relationships and drive alignment across multiple stakeholders will be essential in achieving GCI's objectives and maximizing impact. This position offers an exciting opportunity to lead impactful initiatives in healthcare eligibility and enrollment, contributing to the advancement of healthcare accessibility and affordability for Illinois residents. If you're ready to make a significant difference and drive positive change in the healthcare landscape, we encourage you to apply and join us in this important mission.
Essential FunctionsDirects the strategic implementation of state and federal laws and regulations, new legislative priorities and policy initiatives for eligibility and enrollment for Get Covered Illinois (GCI):- Directs the development and implementation of all provisions of the Affordable Care Act as they relate to health care eligibility and enrollment for GCI.
- Develops, drafts and updates as necessary GCI's eligibility and enrollment policy manual in accordance with existing and new laws, policies, rules, and regulations.
- Directs GCI's response to outside legislative proposals related to health care eligibility and enrollment.
- Collaborates with the Department of Healthcare and Family Services (HFS) on eligibility and enrollment policy interpretation and implementation related to Medicaid.
- Consults and advises the GCI/ Illinois Department of Insurance (DOI) Office of Legal Affairs Division on analysis and interpretation of state and federal regulations.
- Develops and maintains leadership partnerships with HFS and other state agencies in the planning, developing, and implementing joint policies and procedures.
- Participates and represents GCI on federal and state policy forums and advocate for GCI business needs in development of federal and state policy initiatives.
- Ensures that GCI is aware of new and revised federal laws and regulations related to the Affordable Care Act and Illinois health insurance laws and regulations.
Directs the development of strategic initiatives, technology modernization and business solutions to achieve the long-term vision and mission of GCI:- Directs, manages, and prioritizes the development and implementation of business processes, standards, and procedures.
- Address federal and state compliance deficiencies, and ensure compliance with federal and state policies, regulations, and guidelines.
- Ensures that GCI's policy objectives are successfully carried out through the marketplace's eligibility and enrollment platform in accordance with all relevant federal and state laws and regulations.
- Directs and oversees the development of program processes, procedures, and outcome monitoring for compliance with regulations and effectiveness in meeting internal and external customer needs partners with the Marketplace Compliance Director to develop responses to audits of eligibility and enrollment policies and activities.
- Monitors and evaluates GCI's eligibility and enrollment functions and program performance by evaluating agency operations, quality of systems, and program resources.
- Ensures resources are available to engage in improving processes and procedures, develop new policies, and create continuous improvement in the department in matters pertaining to health care eligibility and enrollment.
- Formulates, initiates, and directs the application of GCI policies and procedures to ensure department operations are effectively and efficiently implemented.
Builds, manages, and maintains effective relationships with external stakeholders, including other government agencies, vendors, and federal regulators:- Develops and maintains effective leadership relationships with other state and federal organizations regarding eligibility, enrollment, and policy, including the Departments of Healthcare & Family Services, Human Services, Innovation and Technology and the Governor's Office.
- Represents GCI with external stakeholders, including health insurers, consumer advocate groups, vendors, state and federal leadership, members, and staff of the Illinois Legislature.
Represents GCI at public forums, state and national meetings, before legislative committees, with federal agencies and officials, health care industry leaders, and key vendors speaking on behalf of the Director and Marketplace Director:- Builds and maintains strong relationships and communications with health care industry leaders, key vendors, other stakeholders, the Legislature, and state and federal partners.
- Responds to questions and requests on GCI operational issues from other state agencies, Governor's Office, Legislature, federal agencies and officials, stakeholders, and others.
- Represents GCI and State of Illinois's position on GCI operational issues at state and national meetings, legislative hearings, or other public events and with federal officials.
- Establishes productive relationships and effectively negotiate with federal agencies, other state agencies, health care industry leaders, and key vendors.
- Exercises strict confidentiality on sensitive issues.
Serves as full line supervisor:- Assigns and reviews work.
- Provides guidance and training to assigned staff.
- Counsels staff regarding work performance.
- Reassigns staff to meet day-to-day operating needs.
- Establishes annual goals and objectives.
- Approves time off.
- Adjusts first level grievances.
- Effectively recommends and imposes discipline, up to and including discharge.
- Prepares and signs performance evaluations.
- Determines and recommends staffing needs.
Performs other duties as required or assigned which are reasonably within the scope of the duties enumerated above.Minimum Qualifications1. Requires knowledge, skill, and mental development equivalent to completion of four (4) years of college; preferably with a bachelor's degree.
2. Requires prior experience equivalent to four (4) years of progressively responsible administrative experience in a public or business organization.
Preferred QualificationsPrefers at least four (4) years of related work experience with at least two (2) years in a leadership role.Prefers at least four (4) years of experience utilizing skills at building relationships and trust, managing diverse stakeholders, and driving consensus.Prefers a master's degree in public administration, policy, business administration or a related field, or a Juris Doctorate.Prefers at least four (4) years of experience with the Affordable Care Act and/or state-based healthcare insurance exchanges.Prefers at least four (4) years of experience with eligibility and enrollment policy and systems related to Medicaid, the Affordable Care Act, or other government programs.Prefers at least four (4) years of experience gaining a deep understanding of federal policy and regulatory frameworks.Prefers at least four (4) years of experience utilizing knowledge and understanding of health care policy and systems.Prefers at least four (4) years of experience communicating complex information in a clear and concise manner.Employment ConditionsRequires the ability to pass a background check.Requires ability to travel in the performance of duties, with overnight stays as appropriate.The conditions of employment listed here are incorporated and related to any of the job duties as listed in the job description.About the AgencyThe Department of Insurance (DOI) regulates the insurance market in the State of Illinois including, but not limited to, licensing and educating insurance agents, investigating Workers Compensation fraud, and examining the operations and finances of insurance companies domiciled in the state. We are committed to protecting consumers and regulating the insurance industry with innovation and efficiency. DOI has approximately 220 employees who are split between our Chicago and Springfield offices.
State of Illinois employees enjoy a robust benefit package, including:
- Health, Life, Vision, and Dental Insurance
- 13 Paid Holidays annually, 14 on even numbered years
- 10-25 days of Paid Vacation time annually - (10 days in year one of employment)
- 12 Paid Sick Days annually (sick days carry over from year to year)
- 12 Weeks Paid Maternity/Paternity Leave
- 3 Paid Personal Days annually
- Pension Plan
- Deferred Compensation Program and other pre-tax benefit programs (Medical/Daycare)
- Flexible work schedules may be available, dependent upon position
- Tuition Reimbursement Program and Federal Public Service Loan Forgiveness Program eligibility
Visit for more information about our benefits.
Work Hours: M-F; 8:30am - 5:00pm
Work Location: 122 S Michigan Ave, Chicago, Illinois, 60603
Email: ...@illinois.gov
Phone #: 217-888-888
Posting Group: Leadership & Management
The main form of communication will be through email. Please check your “junk mail”, “spam”, or “other” folder for communication(s) regarding any submitted application(s). You may receive emails from the following addresses:
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