Senior Membership Operations Associate – Retroactivity

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $70k - $85k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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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

• Research escalated and complex retroactive transaction work using CMS guidance, established procedures, and professional judgment • Build repeatable, self-serve operational tooling, including playbooks, intake, readiness trackers, and adoption dashboards • Prepare and submit transactions through MARx, the MAPD Help Desk, and eRPT for applicable effective dates • Monitor case aging against category boundaries and prioritize work based on risk • Track and report category mix, detection latency, aging, and slippage; escalate capacity constraints • Coordinate downstream remediation including claims re-adjudication, pharmacy support, premium adjustments and refunds, subsidy and penalty corrections, prescription drug event corrections, materials and ID card reissuance, and member and provider notification • Serve as a knowledgeable point of contact for escalated member situations involving retroactive corrections • Analyze business impacts, requirements, and recommended actions under applicable federal and state laws, regulations, CMS policy guidance, and contract standards • Monitor non-compliant trends and root causes and collaborate with Enrollment, Sales Compliance, Agent oversight, Product, and Engineering to correct upstream gaps • Maintain complete, reconstructable records of retroactive cases for audit, data validation, and annual readiness • Represent the Membership Operations team when relating with diverse groups of people

🎯 Requirements

• Ability to work in a startup, fast-paced environment • 3-5 years of experience in healthcare, or experience with Medicare or Medicaid requirements • Working proficiency with data tools — spreadsheets at minimum, SQL or similar query experience a strong plus • Experience writing business requirements or partnering with technical teams on operational tooling a plus • Self-motivated, with the desire and flexibility to collaborate with co-workers in a virtual environment as a team player • Entrepreneurial, proactive, and flexible, comfortable in a high-growth environment, with an ability to proactively work across an organization • Compassion for the healthcare challenges facing the Medicare population • Ability to continue to learn and stay current on Medicare initiatives in the marketplace • Direct experience with retroactive enrollment and payment corrections strongly preferred, including RPC submissions and MARx transaction processing • Familiarity with CMS reply and membership reporting, complaint tracking, and grievance processes

🏖️ 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