We are seeking a strategic leader to serve as our resident expert on Medicare Advantage Enrollment and Reconciliation. In this critical role, you won’t just manage data; you will safeguard the integrity of our operations, lead a high-performing team, and ensure our members receive the seamless experience they deserve.

The Opportunity
As the Manager of Enrollment & Reconciliation, you are the bridge between regulatory compliance and operational excellence. You will oversee the entire lifecycle of CMS MARx processing—from transaction submission to complex payment reconciliation—while mentoring a team of specialists to become subject matter experts in their own right.

Key Responsibilities
Subject Matter Expertise: Serve as the "go-to" authority on CMS eligibility policy, MARx transactions, and audit resolution.

Operational Oversight: Lead the submission and resolution of enrollment transactions, ensuring perfect alignment between internal systems, CMS data, and downstream vendors (PBM, Finance, Claims).

Strategic Leadership: Define department priorities, manage resource allocation, and implement corrective action plans to drive efficiency.

Cross-Functional Collaboration: Partner with Plan Leaders and external brokers to resolve complex data discrepancies and drive analytical projects that inform business decisions.

Audit & Compliance: Own the governance of enrollment data, ensuring we are always "audit-ready" and fully compliant with the latest HPMS memos and PCUG guidance.

Who You Are
A Medicare Expert: You have a deep, technical understanding of CMS enrollment rules, retroactive adjustments, and payment reconciliation.

A Proven Leader: You don't just "boss"—you Model the Way, Enable Others to Act, and Encourage the Heart. You have at least 2 years of supervisory experience and 4 years in Medicare health plan operations.

A Data Navigator: You are highly proficient in Excel and can translate complex data sets into actionable insights. Experience with Market Prominence is a significant plus.

A Clear Communicator: You can explain complex regulatory requirements to non-technical stakeholders and provide clear, decisive guidance to your team.

Qualifications
Bachelor’s degree (Master’s preferred) or equivalent experience.

Minimum 4 years of Medicare Enrollment experience at the health plan level.

Minimum 2 years in a supervisory/leadership role.

Expert-level knowledge of MARx transaction codes and CMS response files.

Why Join Us?
We believe in challenging the process and envisioning the future. We offer a collaborative environment where your expertise is valued, your leadership is celebrated, and your work has a direct impact on our members' lives.

Ready to lead our Enrollment strategy? Apply today.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.