Job description
We have an opportunity to join the Alliance as the Medicare Enrollment Specialist in the Medicare Administration Department.
ABOUT THE TEAM AND POSITION
The Alliance is standing up its first Medicare D-SNP going live on January 1st, 2026. This position will work with a small, but mighty, Medicare team made up of dedicated and talented individuals, committed to providing exceptional service to Alliance members. This team is dynamic and flexible, and values collaborative brainstorming, being thought partners for one another, and having a free exchange of ideas for best results and outcomes. This role will have a unique opportunity to help shape processes and workflows, and establish best practices with enrollment functionality to support an optimal customer experience.
WHAT YOU’LL BE RESPONSIBLE FOR
Reporting to the Medicare Operations Director, this position:
- Facilitates the enrollment process into the Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) for those prospective dual-eligible beneficiaries by ensuring timely, compliant, and accurate enrollment processing within the enrollment and eligibility system
- Works with internal and external stakeholders to facilitate Medicare D-SNP enrollment activities
- Tracks and reports on prospective and current member enrollment data and performs other activities in support of the Medicare Operations Department’s enrollment function
THE IDEAL CANDIDATE
- Is a self-starter
- Comfortable navigating ambiguity and works well with little direction
- Meticulously organized and has razor-sharp attention to detail
- Has experience with the Medicare enrollment process and familiarity with CMS guidelines and turnaround times related to enrollment
- Excellent interpersonal skills with emphasis on collaboration
WHAT YOU’LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here
Knowledge of:
- The Medicare member enrollment process and related CMS requirements
- MHK Market Prominence Medicare Advantage member enrollment, billing, and financial reconciliation platform
- The methods and techniques of data entry
- The methods and techniques of system-generated reporting
- Windows-based PC systems, including Microsoft Word, Excel, Outlook and PowerPoint
Ability to:
- Ensure that Medicare D-SNP enrollment activities comply with CMS and DHCS requirements
- Learn Medi-Cal program eligibility requirements and enrollment related regulations, the Medi-Cal Eligibility Data System (MEDS-Lite) and its HIPAA compliant portal
- Understand the interaction between Alliance systems and CMS systems
- Enter, proofread, verify, analyze, and audit data
- Produce organized, accurate, and detail-oriented work and maintain accurate records
Education and Experience:
- High School Diploma or equivalent
- A minimum of four years of experience performing Medicare member enrollments (an Associate’s degree may substitute for one year of the required experience); or an equivalent combination of education and experience may be qualifying
OTHER INFORMATION
- We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
- While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
- In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.
The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate’s qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area
Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area
Zone 1 (Monterey, San Benito and Santa Cruz)
$23—$36.80 USD
Zone 2 (Mariposa and Merced)
$20.93—$33.49 USD
OUR BENEFITS
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
- And many more
ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
Join us at Central California Alliance for Health (the Alliance) is an award-winning regional Medi-Cal managed care plan that provides health insurance for children, adults, seniors and people with disabilities in Mariposa, Merced, San Benito and Santa Cruz counties. We currently serve more than 418,000 members. To learn more about us, take a look at our Fact Sheet.
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.
