Hybrid Senior Enrollment Operations Specialist

Alignment Healthcare USA, LLC in; Orange (CA); Hybrid; USD 41,000 - 62,000; Full time

Job summary

Alignment Health in Orange, CA seeks a Hybrid-Sr. Enrollment Representative to oversee enrollment operations, validate CMS data, and ensure regulatory compliance.

You will reconcile enrollment records, submit MARx files, review DTRR, coordinate with departments, and train team members while supporting SNP eligibility and monthly reconciliations. This role requires 2–3 years of Medicare Advantage enrollment experience, familiarity with MARx/WIPRO, and strong attention to detail in a hybrid office

Qualifications

• Minimum 2–3 years of experience in Medicare Advantage or managed care enrollment operations.
• Demonstrated experience with CMS enrollment systems, MARx processing and WIPRO submission workflows.
• Hands-on experience with enrollment reconciliation, including DTRR review, MMR/TRR file management, and SNP eligibility verification.
• Experience in healthcare, health plan, or insurance operations environment.

Responsibilities

• Research and reconcile enrollment discrepancies identified through CMS reports and system error reports.
• Review and submit daily MARx files to CMS using WIPRO.
• Validate DTRR and ensure timely resolution of enrollment issues.
• Monitor pending enrollments and follow up for additional information as needed.
• Review denials, rejections, and RFIs to ensure CMS compliance and internal policy adherence.
• Reconcile enrollment records between internal systems and CMS files.
• Support monthly Medicaid eligibility reviews and D-SNP membership reconciliations.
• Coordinate enrollment inquiries with internal departments, brokers, and members.
• Serve as escalation point for complex enrollment issues and CMS questions.
• Maintain documentation per regulatory requirements.

Skills

Medicare Advantage

CMS enrollment systems

WIPRO submission

Enrollment reconciliation

Mentoring peers

Education

High school diploma

Associate's or Bachelor's degree

Tools

MARx

WIPRO

EZCAP

Job description

Alignment Health in Orange, CA seeks a Hybrid-Sr. Enrollment Representative to oversee enrollment operations, validate CMS data, and ensure regulatory compliance.

You will reconcile enrollment records, submit MARx files, review DTRR, coordinate with departments, and train team members while supporting SNP eligibility and monthly reconciliations. This role requires 2–3 years of Medicare Advantage enrollment experience, familiarity with MARx/WIPRO, and strong attention to detail in a hybrid office