Eligibility & Enrollment Analyst ACA Marketplace

Job Description

Job Description

Hybrid-Sunrise, Florida

Position Summary : The Eligibility & Enrollment Analyst – Marketplace is responsible for ensuring the accuracy and integrity of member eligibility, enrollment, and reconciliation (ER&R) processes for our ACA Marketplace line of business. This position requires direct experience with Marketplace enrollment operations, including working with CMS systems such as the Federally Facilitated Marketplace (FFM), the Enrollment Reconciliation (ER&R) process, and related eligibility file management. The Analyst will support end-to-end enrollment functions, including member data reconciliation, premium billing support, and resolution of enrollment discrepancies, to ensure compliance with CMS requirements and an excellent member experience.

Essential Duties and Responsibilities :

• Monitor and resolve Marketplace enrollment discrepancies through the CMS ER&R process , ensuring timely and accurate updates to member records.
• Perform daily reconciliation of enrollment data between the CMS Marketplace (FFM), internal health plan systems, and vendor files to identify and correct errors.
• Review eligibility files, including 834 transactions, to ensure alignment with CMS standards and internal enrollment systems.
• Research, analyze, and resolve complex enrollment and premium billing issues related to Marketplace members.
• Serve as a subject matter expert on Marketplace enrollment policies, CMS guidance, and ER&R procedures.
• Assist members with enrollment- and billing-related inquiries, including premiums, grace periods, and coverage effective dates.
• Collaborate with internal departments (Finance, Customer Experience, Business Operations, Account Services) to ensure smooth and compliant enrollment operations.
• Escalate systemic or recurring enrollment and reconciliation issues and recommend process improvements.
• Support monthly and quarterly CMS reconciliation cycles, including enrollment reports, discrepancy resolution, and attestation requirements.
• Maintain detailed documentation of enrollment and reconciliation activities in accordance with CMS audit standards.
• Perform other eligibility and enrollment-related duties as assigned.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications :

Preferred Qualifications :

Skills and Abilities :

Strong analytical skills with the ability to interpret large data sets, identify discrepancies, and implement corrective actions.

Ability to research, analyze, and resolve complex enrollment and billing issues while ensuring compliance with ACA and CMS regulations.

Clear, professional verbal and written communication skills; able to explain technical enrollment concepts to both internal teams and members.

Strong organizational and time-management skills; able to prioritize multiple deadlines in a fast-paced environment.

Work Schedule :

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs

Physical Demands :

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee may occasionally be required to stoop, kneel, crouch or crawl. The employee may occasionally lift and / or move up to 15 pounds.

Work Environment :

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside / outside the office, travel to other offices, as well as domestic travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating, and preserving a culture of diversity, equity, and inclusion.