[Hiring] Membership Operations Senior Associate @Devoted Health

Role Description

The Senior Associate, on the Membership Operations team, is a key player within a pivotal function. Devoted Health's Membership Operations team is entrusted with the R&D and operational execution behind the integrity of our members' data — the data that everything else in health plan operations depends on.

• SNP eligibility validation
• Enrollment
• Member Data Integrity
• Member Financial Integrity
• Member and Payment Reconciliation
• Quality Management
• Strategy

Retroactivity cuts across all of them. When a member's enrollment record is wrong — wrong plan, wrong county, wrong effective date, wrong subsidy status, or missing entirely — the correction is retroactive, and it touches enrollment, payment, claims, pharmacy, and premium billing simultaneously.

Your Responsibilities and Impact will include:

• Researching escalated and complex retroactive transaction work by drawing on CMS guidance, established procedures, and professional judgment.
• Assist in building the tooling that makes change repeatable: playbooks, intake, readiness trackers, adoption dashboards.
• Prepare and submit transactions through the appropriate channel — internal processing via MARx and the MAPD Help Desk for current and prior month effective dates, and RPC submission via eRPT for older effective dates.
• Monitor case aging against category boundaries and prioritize work by the risk of a case aging out of a favorable category.
• Track and report on category mix, detection latency, aging, and slippage; escalate capacity constraints before they translate into aged cases.
• Coordinate downstream remediation so members are made whole: 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.
• Maintain established confidence in applicable federal and state laws, regulations, CMS policy guidance, and contract standards.
• Monitor and analyze non-compliant trends and root causes, and collaborate with stakeholders to correct upstream gaps.
• Maintain a complete, reconstructable record of retroactive cases sufficient to support audit, data validation, and annual readiness.
• Relate openly and comfortably with a diverse group of people as a representative of the Membership Operations team.

Qualifications

• 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.
• Compassion for the healthcare challenges facing the Medicare population.
• Ability to continue to learn and stay current on Medicare initiatives in the marketplace.

Requirements

• 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; Commission eligibility for Sales roles.
• Parental leave program.
• 401K program.
• And more....