Eligibility & Enrollment Operations Manager (Remote)

Devoted Health Services, Inc; Waltham (MA); On-site; USD 73,000 - 114,000; Full time

Benefits offered by this job

Health, dental & vision coverage

401K

Stock options

Parental leave

Job summary

Devoted Health is seeking a Manager, Eligibility & Enrollment to lead a team responsible for Medicare Advantage enrollment operations, disenrollment, plan changes, and retroactive adjustments across HMO, PPO, and SNP products. You will ensure CMS compliance, timely processing, and accurate member records.

You will oversee workflow, audits, and QA, while coaching staff to meet department KPIs, SLAs, and quality standards. Remote work with peak coverage availability is required.

Qualifications

• 4+ years in Medicare Advantage eligibility and enrollment operations, including supervisory or team lead experience.
• Working knowledge of CMS enrollment/disenrollment regulations for HMO/PPO/SNP products, including election periods and retroactive processing.
• Hands-on CMS MARx processing, response files, and membership reconciliation.
• Experience supporting CMS or internal audits, including universe prep and case documentation.
• Strong analytical and root-cause skills, with Excel and reporting/monitoring tools.

Responsibilities

• Manage daily workflow, queues, and transaction inventory for enrollments, disenrollments, plan changes, cancellations, and retroactive adjustments within CMS and SLAs.
• Monitor CMS MARx submissions, response files, and error reports; research and resolve rejections and discrepancies timely.
• Serve as escalation point for complex cases; make case-level decisions per CMS guidance and policy.
• Supervise, coach, and develop associates; manage staffing, onboarding, and performance against KPIs.
• Plan capacity for peak periods (AEP/OEP) and ensure no backlog; conduct quality reviews and audits.

Job description

Devoted Health is seeking a Manager, Eligibility & Enrollment to lead a team responsible for Medicare Advantage enrollment operations, disenrollment, plan changes, and retroactive adjustments across HMO, PPO, and SNP products. You will ensure CMS compliance, timely processing, and accurate member records.

You will oversee workflow, audits, and QA, while coaching staff to meet department KPIs, SLAs, and quality standards. Remote work with peak coverage availability is required.