Hybrid-Sr. Enrollment Representative (Orange, CA)

About the role

The Senior Enrollment Representative plays a crucial role in ensuring accurate and timely enrollment processing for Alignment Health, a company dedicated to serving seniors and those in need. Reporting to the Enrollment Manager, this role involves managing and supporting all enrollment operations, ensuring compliance with CMS regulations and internal policies.

Responsibilities

• Research and reconcile enrollment discrepancies identified through CMS reports, internal audits, and system-generated error reports
• Review and submit 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
• 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, ensuring 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

Requirements

• 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
• Prior experience mentoring or training peers in enrollment processes
• Experience supporting D-SNP and C-SNP program reconciliation in a Medicare Advantage plan setting

Preferred

• High school diploma or equivalent required
• 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

Minimum Requirements

• 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

Supervisory Responsibilities

N/A

Work Environment

This is a hybrid position with an expectation of working in the office three days per week, typically on Monday, Wednesday, and Friday, although schedules may be adjusted based on business needs. Employees may work remotely on the remaining two days, generally Tuesday and Thursday, providing a balance between in-person collaboration, team engagement, and remote productivity.

Pay Range

$41,472.00 - $62,208.00

Company Information

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.