Hybrid-Sr. Enrollment Representative (Orange, CA)

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Senior Enrollment Representative is responsible for overseeing and supporting all enrollment operations, including researching, validating, reconciling, and processing. This role serves as a subject matter expert for enrollment processes, CMS regulations, and internal systems while providing guidance, training and operational support to the Enrollment team. The Sr Enrollment Representative ensures accurate and timely enrollment processing, regulatory compliance, data integrity, and resolution of enrollment discrepancies.

General Duties/Responsibilities (May include but are not limited to): 

• Research and reconcile enrollment discrepancies identified through CMS reports, internal audits, and system-generated error reports
• Review and submit of 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.
• Support monthly Medicaid eligibility reviews and Dual Eligible Special Needs Plan (D-SNP) membership reconciliations.
• 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. Ensure 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.

Job Requirements: 

Experience:

Required:

• 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

• Experience with EZCAP or similar health plan membership management systems
• Prior experience mentoring or training peers in enrollment processes
• Experience supporting D-SNP and C-SNP program reconciliation in a Medicare Advantage plan setting

Required:

• High school diploma or equivalent required

Preferred:

• 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

SUPERVISORY RESPONSIBILITIES:

N/A

Minimum Requirements: 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.    

• 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. 

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. This flexible work arrangement supports effective communication, relationship building, and operational efficiency.

Licensure:

• Required: None

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

Pay Range: $41,472.00 - $62,208.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

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.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.