Medicare Operations Analyst
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Job Description
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Reporting to the Medicare Operations Director, this position supports Medicare operations, sales, and enrollment functions through analysis and interpretation of Medicare and Medi-Cal data, ensuring compliance with state and federal regulations.
WHAT YOU’LL BE RESPONSIBLE FOR
- Conducts complex research and analysis in support of Medicare Operations activities
- Acts as a subject matter expert and liaison to internal and external stakeholders
WHAT YOU’LL NEED TO BE SUCCESSFUL
To read the full position description and list of requirements, click here.
- Knowledge of:
- CMS guidelines related to Medicare sales and enrollment
- Medicare Advantage enrollment processes and financial reconciliation
- Contents and interpretation of monthly membership reports
- Research, analysis, and reporting methods
- Data analysis tools, CRM/enrollment systems, and the use of databases
- Ability to:
- Analyze complex data sets and present actionable insights
- Identify issues, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action
- Interpret, explain, and apply applicable policies, laws, codes, regulations, and contracts
- Organize work, manage multiple projects, establish priorities, adjust to changing priorities, and meet deadlines
- Assist with the development and implementation of projects, systems, programs, policies, and procedures
- Develop and implement operational workflows
- Education and Experience:
- A Bachelor’s degree in Business Administration, Health Care Administration, Public Health, or a related field
- A minimum of five years of progressively responsible experience related to Medicare membership operations and/or enrollment eligibility
- A Master’s degree may substitute for two years of the required experience; or an equivalent combination of education and experience may be qualifying
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The Alliance
View Company ProfileThe Alliance (operating at thealliance.health) is a health insurance platform engineered for providing Medi-Cal insurance to residents in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. Founded in 1996 by unknown founders and headquartered in Scotts Valley, CA, The Alliance helps self-funded employers control costs and uncover savings while improving access to high-value care for employees and their families. Under the hood, The Alliance utilizes the State's County Organized Health System (COHS) to provide trusted, no cost Medi-Cal health care from local teams to families. This allows residents to access essential health services. Backed by a total funding of $16.6M over 5 rounds.
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