Enrollment Services - Marketplace Reconciliation Analyst 160-1027

About the role

This Analyst will help ensure enrollments are reconciled regularly with our vendor and with the Federally Facilitated Marketplace (FFM). The role involves reviewing various transactions and reports to align Marketplace enrollment data, including records on CCOK, CMS, and vendor systems, and submitting corrections as needed.

Responsibilities

• Identifies and resolves discrepancies between CCOK’s system, the vendor’s system, and the FFM’s system.
• Works with the vendor to provide analysis of any metrics categories requested by the CMS Account Manager.
• Reviews the Enrollment Alignment Performance Summary Reports (EAPS) to ensure timely reconciliation and initiates necessary corrections.
• Reviews Pre-Audit files to ensure enrollment data matches across all systems.
• Reviews Untitled “I” Record (UIR) and makes updates as needed per policy.
• Reviews 1095A Update reports to ensure notification is sent to members whose 1095A form is updated due to enrollment changes.
• Assists internal departments with enrollment issues and questions.
• Maintains compliance with CMS guidelines related to enrollment reconciliation.
• Reviews and updates policies and procedures.
• Performs other duties as assigned.

Requirements

• Strong oral and written communication skills.
• Ability to read, analyze, and interpret complex reports.
• Strong problem-solving and critical-thinking skills.
• Ability to work on multiple projects concurrently.
• Proficient in Microsoft and database applications.
• Successful completion of a Health Care Sanctions background check.
• Highly organized and attentive to detail.

Qualifications

• High school diploma or equivalent.
• Minimum five years of experience in a healthcare-related environment (preferred).
• Marketplace administration experience (preferred).