Director of Membership Reconciliation Specialist

3 weeks ago


Tampa, Florida, United States Wipro Digital Operations and Platforms Full time
Wipro Digital Operations and Platforms

Job Title: Director of Membership Reconciliation Specialist

Salary Range: $120,000 - $180,000 per year

About the Job

We are seeking a highly skilled Service Delivery Leader to oversee accurate and compliant reconciliation of enrollment and membership data for the ACA Marketplace and Exchange line of business.

This role requires strong leadership, analytical, and project management skills, with expertise in healthcare enrollment reconciliation, specifically within the ACA Marketplace and Exchange line of business.

The ideal candidate will have a deep understanding of enrollment, membership operations, and reconciliation processes, including but not limited to 834, 820, RCNO, RCNI, EAPS, HICS, and other CMS and state-specific files.

Responsibilities
  • Lead a team responsible for accurate and compliant reconciliation of enrollment and membership data for the ACA Marketplace and Exchange line of business.
  • Oversee the reconciliation of 834 and 820 files, RCNO, RCNI, EAPS, HICS, and other relevant CMS files, using innovative solutions to enhance and automate processes.
  • Collaborate with IT teams, Project Managers, and Business Partners to develop detailed Business Requirements based on analytic research and Root Cause Analysis.
Requirements
  • Bachelor's degree in a relevant field; an advanced degree is preferred.
  • Extensive experience in healthcare enrollment reconciliation, specifically within the ACA Marketplace and Exchange line of business.
  • Strong understanding of CMS files including 834, 820, RCNO, RCNI, EAPS, HICS, and other relevant reconciliation files.


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