Medicare Enrollment Reconciliation Specialist

This position is responsible for ensuring alignment between Medicare Advantage membership enrollment records and CMS enrollment records. This involves reviewing Daily Transaction Reply Reports and Monthly Membership Reports while adhering to CMS guidelines.

Location: Remote (Candidates must be based in NJ/NY)

Key Responsibilities:

• Reconcile daily, weekly, and monthly Medicare reports from CMS.
• Research and resolve enrollment discrepancies between company records and CMS reports.
• Respond promptly and professionally to internal and external inquiries, including those from Medicare beneficiaries, regulators, executives, and Congress.
• Ensure compliance and accuracy of member correspondence regarding retroactive enrollment submissions to CMS.
• Identify and communicate performance improvement opportunities in processing.
• Update beneficiary enrollment requests for premium withholding.
• Ensure timely resolution of enrollment discrepancies in accordance with CMS timeframes.
• Prepare documentation for retroactive enrollment updates.
• Perform additional duties as assigned.
  
  

Core Competencies:

• Customer Focus
• Accountability
• Communication
• Continuous Learning
  
  

Qualifications:

• High school diploma or GED required; Bachelor’s degree preferred.
• Minimum 5 years of experience in health insurance or Medicare.
• Strong analytical and problem-solving skills.
• Excellent oral and written communication skills.
• Proficiency in data analysis techniques and Microsoft Access.
• Knowledge of CMS regulations and system development life cycles preferred.