Enrollment & Reconciliation Specialist

Enrollment Reconciliation Specialist AlohaCare is a local, non-profit health plan serving Hawai`i's low-income residents with free Medicaid and dual Medicare health insurance coverage. Our members include children, seniors and adults residing on all islands. We provide comprehensive benefits and managed care services with an emphasis on healthy living habits and preventive primary health care. Our approach is to meet the whole-person health and social needs of members. Through our community partnerships we offer innovative services such as connection to social service agencies, Native Hawaiian healing services and in-home primary care for qualified members. Our mission is to serve in the true spirit of aloha by ensuring and advocating for access to quality health care for all. We are Hawaii's third-largest health plan and offer a wide network of quality primary care, specialists, hospitals, pharmacies and among many other providers across the state. AlohaCare employees have a passion for helping Hawai`i's most underserved communities. Our caring culture is fundamental to our company-wide team approach to providing high quality services. We support our employees with a supportive and positive work environment, healthy work-life balance, continuous communication, and a generous benefits package. AlohaCare'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. AlohaCare'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.

Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met. In office working environment. May require prolonged sitting- up to 4 hours. Requires prolonged operation of a computer workstation, including the ability to type for extended periods of time on a keyboard during the scheduled workday.

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws. Our policy prohibits discrimination and harassment because of race, color, religion, sex (including gender identity or expression), pregnancy, age, national origin, ancestry, marital status, arrest and court record, disability, genetic information, sexual orientation, domestic or sexual violence victim status, credit history, citizenship status, military/veteran status, or other characteristics protected under applicable state and federal laws, regulations, and/or executive orders.