Overview In this role you lead end-to-end ACA Marketplace reconciliation for Individual Dental plans, ensuring accuracy, compliance, and timely execution. You act as the primary SME and liaison for enrollment and policy-based payment reconciliation, working closely with cross-functional teams and external vendors. You translate findings into practical recommendations to improve processes, data integrity, and control effectiveness. You drive data-driven improvements to reduce aging, shorten resolution times, and strengthen first-contact resolution, aligning with regulatory and audit expectations. This role offers meaningful impact in shaping sustainable, compliant reconciliation outcomes at scale.
Responsibilities- Own end-to-end ACA Marketplace reconciliation for Individual Dental plans, including controls, monitoring, discrepancy management, financial alignment, reporting, and escalation.
- Serve as the primary subject matter expert and accountable contact for enrollment and policy-based payment reconciliation across Individual Dental Operations.
- Act as the enrollment-alignment contact for the Centers for Medicare & Medicaid Services.
- Independently research complex enrollment and financial discrepancies, determine root cause and corrective action.
- Develop trend analyses and insights to improve accuracy, reduce aging, and enhance resolution efficiency.
- Use data-driven analysis to prioritize work, improve data quality, and increase efficiency.
- Maintain knowledge of federal and state regulations applicable to ACA Dental reconciliation.
- Perform independent quality reviews of reconciliation processes, evidence, and reporting to ensure accuracy and compliance.
- Establish quality review standards, criteria, and acceptance thresholds; identify trends and remediation priorities.
- Coordinate regulatory, financial, operational, and audit requests with timely evidence and closure.
- Oversee vendor performance, resolve discrepancies, and promote sustainable reconciliation outcomes.
- Provide objective challenge on operational, control, technology, and vendor changes; ensure auditable solutions.
- Lead or support ACA Medical reconciliation during wind-down and regulatory runout periods.
Key requirements- Bachelor degree in a relevant field (implied).
- At least five years in healthcare insurance operations, enrollment, billing, financial reconciliation, or related discipline.
- Experience with ACA Individual Marketplace reconciliation preferred.
- Ability to own complex operational responsibilities and drive results in a matrixed environment.
- Strong knowledge of operational controls, regulatory compliance, audit readiness, issue management, and root-cause analysis.
- Experience performing quality assurance, control testing, or independent reviews with actionable recommendations.
- Proficiency with Microsoft Excel, Word, PowerPoint, and Outlook; reporting or data visualization tools preferred.
- strong analytical thinking
- excellent communication
- stakeholder management
- Microsoft Excel
- Microsoft Word
- Microsoft PowerPoint
