Hybrid-Sr. Enrollment Representative (Orange, CA)

Requirements

• Required:
• Minimum 2-3 years of experience in Medicare Advantage or managed care enrollment operations
• Demonstrated experience with CMS enrollment systems, including MARx processing and WIPRO submission workflows
• Hands-on experience with enrollment reconciliation, including DTRR review, MMR/TRR file management, and SNP eligibility verification
• Experience working in a healthcare, health plan, or insurance operations environment
• Experience with EZCAP or similar health plan membership management systems
• Prior experience mentoring or training peers in enrollment processes
• Experience supporting D-SNP and C-SNP program reconciliation in a Medicare Advantage plan setting
• High school diploma or equivalent required
• Preferred:
• Associate's or Bachelor's degree in Health Administration, Business Administration, or a related field
• Additional coursework or certification in healthcare compliance, managed care operations, or Medicare regulations
• SUPERVISORY RESPONSIBILITIES:
• N/A
• Minimum Requirements:
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
• High school diploma or equivalent required.
• Experience in a healthcare or insurance setting, especially Medicare, is a plus.
• Basic computer skills (Microsoft Office, scanning software, database entry).
• Strong attention to detail and organizational skills.
• Ability to work independently and as part of a team.
• Excellent time management and multitasking abilities.
• Work Environment:
• Licensure:
• Required: None
• Essential Physical Fu

Benefits

Additional Information

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together. The Senior Enrollment Representative is responsible for overseeing and supporting all enrollment operations, including researching, validating, reconciling, and processing. This role serves as a subject matter expert for enrollment processes, CMS regulations, and internal systems while providing guidance, training and operational support to the Enrollment team. The Sr Enrollment Representative ensures accurate and timely enrollment processing, regulatory compliance, data integrity, and resolution of enrollment discrepancies. General Duties/Responsibilities (May include but are not limited to): Research and reconcile enrollment discrepancies identified through CMS reports, internal audits, and system-generated error reports Review and submit of daily MARx files to CMS utilizing WIPRO Ensure Daily Transaction Reply Report (DTRR) are validated, and all transactions are reviewed timely for resolution of enrollment issues. Monitor pending enrollments and follow up on requests for additional information to ensure timely processing. Review enrollment denials, rejections, and requests for information (RFIs) to ensure compliance with CMS requirements and internal policies. Reconcile enrollment records between internal systems and CMS files. Support monthly Medicaid eligibility reviews and Dual Eligible Special Needs Plan (D-SNP) membership reconciliations. Coordinate and resolve enrollment-related inquiries from internal departments, brokers, sales representatives, providers, and members. Serve as a resource and escalation point for complex enrollment issues and CMS-related questions. Maintain accurate documentation and records in accordance with departmental and regulatory requirements. Act as a liaison to the Sales Representatives. Ensure that new enrollments are processed properly. Provide any issues identified to the necessary internal department Leadership team Data entry of all enrollment applications into plan's data system. Verify eligibility for Special Needs Plans (SNP) enrollments as well as ensure that all qualifying documentation is included with enrollment application. Responsible for the monthly discrepancy reconciliation files. Job Requirements:

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