Classicare Reconciliation Analyst

About the role

The Classicare Reconciliation Analyst is responsible for ensuring accurate reconciliation of electronic transactions between the company’s internal systems and various regulatory agencies and delegated entities. This role supports premium collection, regulatory compliance, and audit readiness.

Key responsibilities

• Validate and reconcile membership, electronic transaction, and payment data across internal platforms, CMS, ASES Medicaid, PBM and delegated entity systems.
• Identify error patterns, coordinate corrections with relevant departments, and report outcomes to management.
• Monitor incoming files from CMS, PBM, ASES and Medicaid, and transmit required files or reports to meet contractual and regulatory obligations.
• Analyze reconciliation results, document discrepancies, and submit corrected electronic transactions to CMS.
• Assist with retroactive transaction submissions, state and county code changes, and preparation of statistical reports for business analysis.
• Participate in audits, internal reviews, and maintain comprehensive documentation of regulatory and operational processes.
• Support system upgrades, user acceptance testing, and implementation of new reconciliation tools, including validation test reporting.

Required profile

• Strong attention to detail and ability to work with large data sets.
• Experience in healthcare or insurance environments dealing with regulatory agencies.
• Proven ability to document processes and maintain audit trails.
• Effective communication skills for cross‑departmental collaboration.

Required skills

• Familiarity with CMS electronic transaction standards.
• Understanding of Medicaid, ASES, and PBM data flows.
• Experience with reconciliation tools and reporting systems.