Financial Reconciliation Manager

Role Overview

• Lead end-to-end financial reconciliation processes across premium billing, and payment workstreams
• Reconcile data across Facets (including 834s) and FRM, and downstream financial systems to ensure consistency and accuracy
• Perform variance analysis to uncover financial leakage, misapplied payments, or configuration-driven errors
• Analyze and support Facets and FRM configuration to ensure financial outcomes align with contract intent
• Partner with configuration and IT teams to troubleshoot financial discrepancies tied to system setup or rule logic
• Ensure alignment between financial reporting outputs
• Ensure reconciliation processes support CMS, Medicare Advantage, and Medicaid financial and reporting requirements
• Support financial validation for risk adjustment and regulatory reporting
• Prepare and review financial data used for audits, compliance checks, and external reporting
• Validate cross-system data to ensure accurate financial reporting and reduce revenue leakage risks
• Develop and implement solutions to improve data quality, reconciliation accuracy, and financial transparency
• Partner with Finance, Actuarial, Enrollment, EDI, and IT teams to resolve reconciliation and reporting issues
• Translate business and financial requirements into clear reconciliation frameworks and system requirements
• Provide strategic guidance to clients on best practices for financial operations and reconciliation processes
• Design and implement automated reconciliation processes and reporting tools
• Support system testing (UAT, regression, validation) to ensure financial accuracy
• Document reconciliation methodologies, controls, and operational procedures

Requirements

• 5+ years working experience within Healthcare Payer Operations
• 5+ years of healthcare payer experience (Medicare and Medicaid)
• 5+ years of experience in financial reconciliation, billing analysis, or payer financial operations
• 5+ years of hands-on experience with Facets (TriZetto), particularly with FRM
• Strong expertise in: Financial workflows, 834 transactions and EDI data structures, Reconciliation processes across premium billing
• Proven ability to: Identify and resolve complex financial discrepancies, Analyze large datasets and perform root cause analysis
• Experience working in a consulting or client-facing environment
• Experience with collaboration & team communication

Benefits

• medical, dental, and vision coverage to employees and dependents
• a 401(k) plan with a generous employer match
• an employee stock purchase plan
• a generous Paid Time Off policy
• paid parental leave and adoption assistance
• free annual health screenings and coaching
• bank at work
• on-site workshops