Manager, Eligibility & Enrollment

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $73k - $114k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Manage daily workflow, work queues, and transaction inventory for enrollments, disenrollments, plan changes, cancellations, and retroactive adjustments across HMO, PPO, and SNP products • Monitor CMS MARx submissions, response and reply files, and error reports; research and resolve rejections and discrepancies • Reconcile membership accurately and on time each month • Serve as first escalation point for complex and exception-based cases • Supervise, coach, hire, onboard, schedule, and manage performance of Enrollment/Eligibility Associates • Set individual production and quality goals tied to department KPIs; own team productivity, quality, engagement, and retention • Plan capacity and coverage for AEP, OEP, and Special Election Periods • Perform and document quality reviews against CMS guidance and internal controls • Support CMS, internal, and external audits by preparing universes, pulling case files, validating samples, and answering auditor questions • Execute corrective action plans and close findings on time • Translate new CMS guidance and memos into workflow changes, updated job aids, procedures, and staff training • Identify recurring errors and rework drivers; implement process improvements and automation opportunities • Build and maintain monitoring notebooks and views for volume, aging, throughput, accuracy, timeliness, and reconciliation completion • Partner on AI-agent design and use under a human-in-the-loop model, including review requirements, quality checkpoints, controls, and coaching • Partner with Member Services, Billing, Data Reconciliation, Compliance, Sales, Agent Support, and Tech on member-impacting issues, defects, interfaces, UAT, upgrades, products, and plan expansions • Support the Senior Manager with leadership materials, analysis, CMS inquiries, and governance forums

🎯 Requirements

• 4+ years in Medicare Advantage eligibility and enrollment operations, including at least 2 years in a supervisory or team lead role • Working knowledge of CMS enrollment and disenrollment regulations for HMO, PPO, and SNP products, including election periods, effective dating, and retroactive processing rules • Hands-on experience with CMS MARx transaction processing, response and reply file handling, and membership reconciliation • Experience supporting CMS or internal audits, including universe preparation and case documentation • Strong analytical and root-cause problem-solving skills on complex transaction and eligibility discrepancies • Proficiency in Excel and reporting tools for inventory tracking, trend analysis, and audit sampling • Ability to learn and build notebooks for metric monitoring and reporting • Willingness to work directly in AI-assisted processes under a human-in-the-loop model • Effective written and verbal communication, with the ability to explain regulatory requirements to staff and non-technical partners • Proven ability to manage competing priorities and high-volume workloads in a deadline-driven, regulated environment • Demonstrated commitment to data accuracy and member confidentiality (HIPAA) • Bachelor's degree in Business, Health Administration, or a related field; an equivalent combination of education and directly relevant Medicare enrollment experience will be considered • Ability to work remotely with availability to support extended coverage during AEP, OEP, and other peak enrollment periods • Health plan, MSO, or TPA experience preferred, with proficiency in QNXT, Facets, HealthEdge, or similar platforms and CMS data exchange tools including HPMS • Experience designing or overseeing AI agents in an operational workflow preferred • Master's degree (MBA, MHA, or similar) preferred

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Parental leave program • 401K program