Enrollment & Reconciliation Specialist

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Aloha Care’s leadership empowers and engages its employees by recognizing outstanding job performance and collaboration. We share organization-wide updates during quarterly All Staff meetings. We encourage participation in volunteer and educational opportunities. We put a high value on honesty, respect, and trust-building. We encourage open-door, two-way, and frequent communication.

Aloha Care’s comprehensive benefits package includes low-cost medical, dental, drug and vision insurance, paid time-off, 401k employer contribution, referral bonus and pretax transportation and parking program.

The Enrollment Reconciliation Specialist provides advanced operational oversight of Medicare D-SNP enrollment reconciliation and CMS/MARx transactions. This role is responsible for identifying, researching, and resolving complex enrollment discrepancies that may impact member eligibility, claims, pharmacy, accumulations and regulatory reporting.

The position serves as a subject matter resource to Enrollment and Plan Operations, coordinating with internal departments, CMS and other stakeholders to ensure enrollment data is accurate, timely, and fully reconciled across systems.

• Research root causes of enrollment discrepancies and develop appropriate corrective actions.
• Manage and track member reinstatements, retroactive enrollment changes, and CMS transaction corrections through resolution.
• Reconcile Medicare D-SNP enrollment with applicable Medicaid/QUEST eligibility and identify issues affecting member eligibility.
• Validate enrollment changes and their downstream impact on claims, pharmacy, member benefits, accumulations and other operational systems.
• Maintain detailed reconciliation tracker, issue logs, audit documentation, and management reporting.
• Identity trends and recurring issues and perform root cause analysis and process improvement.
• Provide guidance and subject matter expertise to enrollment staff on complex reconciliation issues and CMS transactions.
• Develop and maintain reporting that provides leadership with visibility into enrollment status, outstanding discrepancies, transaction activity, risk, and resolution progress.
• Escalate significant enrollment issues and potential members or financial impacts to leadership.
• All other duties assigned.
• Adhere to regulatory compliance and quality guidelines as well as Aloha Care policies and procedures.
• Responsible for maintaining Aloha Care’s confidential information in accordance with Aloha Care policies, and state and federal laws, rules and regulations regarding confidentiality. Employees have access to Aloha Care data based on the data classification assigned to this job title.
• Strong knowledge of CMS/MARx enrollment processes.
• Experience working with Medicare Advantage and preferably D-SNP/Medicaid populations.
• Advanced Excel and data-reconciliation skills
• Demonstrated ability to independently research complex enrollment issues and determine appropriate resolution.
• Achieves results, builds trust, communicate effectively, customer and quality focused.
• Able to work independently with minimal supervision.
• Able to effectively work in a fast-paced and changing environment, manage multiple projects and priorities across multiple teams/projects and in a matrixed environment.
• Possesses excellent time management and organizational skills; is dependable, enthusiastic, self-starting, and self-motivated. Uses time effectively, reacts professionally under pressure.
• Data entry experience with a high degree of accuracy and attention to…