Financial Reconciliation Manager (FRM)

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Financial Reconciliation Manager (FRM) in United States.

This role offers an exciting opportunity to support large-scale healthcare payer organizations by driving financial accuracy, operational efficiency, and regulatory compliance across critical reconciliation processes. As a subject matter expert in healthcare financial reconciliation and payer operations, you will work across premium billing, payment validation, and cross-system financial reporting to ensure integrity and transparency in complex healthcare environments. The position involves close collaboration with finance, IT, actuarial, enrollment, and operations teams to identify discrepancies, optimize workflows, and improve reconciliation methodologies. You will play a key role in reducing revenue leakage, supporting government program compliance, and enhancing data quality across enterprise systems. This is a highly visible, client-facing role ideal for professionals who enjoy solving complex operational challenges while contributing to meaningful improvements in healthcare financial operations. The environment is collaborative, fast-paced, and focused on innovation, continuous improvement, and measurable client impact.

• Lead end-to-end financial reconciliation processes across premium billing, payment workflows, and financial reporting operations.
• Reconcile financial and enrollment data across multiple systems, including healthcare payer platforms and downstream financial systems, ensuring consistency and accuracy.
• Conduct variance analysis to identify financial leakage, payment discrepancies, configuration issues, and operational inefficiencies.
• Collaborate with IT, configuration, actuarial, enrollment, EDI, and finance teams to troubleshoot and resolve reconciliation and reporting issues.
• Support regulatory and compliance reporting requirements related to Medicare, Medicaid, CMS, and other government healthcare programs.
• Validate financial data used for audits, risk adjustment activities, and external reporting to maintain financial integrity and compliance.
• Design and improve reconciliation methodologies, controls, reporting frameworks, and automated processes to enhance operational efficiency.
• Translate operational and financial business requirements into scalable reconciliation frameworks and system requirements.
• Support system testing activities including UAT, regression testing, and validation to ensure financial accuracy across implementations and updates.
• Develop documentation for reconciliation processes, governance standards, controls, and operational procedures.

Requirements:

• 5+ years of experience in healthcare payer operations, including Medicare and Medicaid environments.
• 5+ years of experience in financial reconciliation, billing analysis, payer financial operations, or related healthcare finance functions.
• Hands-on expertise with TriZetto Facets and Financial Reconciliation Manager (FRM), including configuration and reconciliation workflows.
• Strong understanding of healthcare financial workflows, premium billing processes, EDI transactions, and 834 data structures.
• Proven ability to identify and resolve complex financial discrepancies through root cause analysis and data investigation.
• Experience analyzing large datasets and supporting operational or financial reporting improvements.
• Strong collaboration and communication skills with experience working in consulting or client-facing environments.
• Familiarity with risk adjustment validation, audit support, payment discrepancy analysis, and financial reporting processes is preferred.
• Experience with SQL, data analytics tools, or large-scale payer system implementations is highly valued.
• Exposure to AI-enabled tools such as ChatGPT, Claude, or Copilot is considered a plus.
• Strong organizational skills with the ability to manage multiple priorities in a fast-paced, highly collaborative setting.

Benefits:

• Competitive compensation package with performance-driven career growth opportunities
• Remote work flexibility within the United States
• Comprehensive medical, dental, and vision insurance coverage
• 401(k) plan with generous employer matching contributions
• Employee stock purchase plan
• Generous paid time off and paid parental leave programs
• Adoption assistance and family support benefits
• Wellness programs including health screenings, coaching, and employee well-being initiatives
• Collaborative and inclusive work culture focused on innovation and continuous learning
• Opportunities to work on high-impact healthcare transformation projects
• Access to professional development, mentorship, and career advancement resources.