Medicare Operations Analyst

Jobgether; California City (CA); Remote; USD 110,000 - 150,000; Full time

Benefits offered by this job

Health coverage

Paid time off

12 holidays per year

401(a) retirement plan

457 plan

Job summary

Jobgether is seeking a Medicare Operations Analyst to support Medicare operations, enrollment, and reporting. This remote role, based in the United States and serving California communities, emphasizes data analysis, regulatory interpretation, and cross-team collaboration.

You will translate complex data into actionable insights, help refine enrollment processes, and ensure regulatory compliance across Medicare activities. A strong background in data analysis and CMS guidelines is essential.

Qualifications

• Bachelor’s degree in a relevant field and 5+ years in Medicare operations or enrollment.
• Familiarity with CMS guidelines governing Medicare sales and enrollment.
• Experience interpreting Medicare data and regulatory requirements.

Responsibilities

• Analyze Medicare and Medi-Cal data to support operations, sales, and enrollment.
• Perform complex research to inform operational decisions and initiatives.
• Review membership reports; identify trends and reconciliation insights.
• Apply CMS guidelines and state/federal regulations to sales and enrollment.
• Serve as SME and liaison for internal teams and external stakeholders.
• Support projects, systems, policies, and procedures development.
• Manage multiple projects, meet deadlines, and adapt to changes.
• Communicate findings clearly to support informed decisions.

Skills

CMS guidelines

Medicare enrollment

Data analysis

Stakeholder management

Project management

CRM systems

MarketProminence

Education

Bachelor's degree in Business Administration

Bachelor's degree in Healthcare Administration

Tools

MarketProminence

CRM software

Job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medicare Operations Analyst based in the United States.

As a Medicare Operations Analyst, you will support critical Medicare operations, sales, and enrollment activities through detailed data analysis, research, and regulatory interpretation. You will help ensure accurate membership reporting and compliance with applicable state and federal requirements while identifying opportunities to improve operational performance. Working closely with internal teams and external stakeholders, you will translate complex data into actionable insights and practical recommendations. Your expertise will contribute to effective enrollment processes, reliable reporting, and well-informed business decisions. You will also help develop and refine operational workflows, systems, and procedures in a mission-driven healthcare environment.

This remote opportunity is particularly suited to candidates based in or near the communities served across California's Central Coast and surrounding counties.

Reporting to the Medicare Operations Director, you will provide analytical and operational support across Medicare activities, helping strengthen enrollment processes, maintain regulatory compliance, and improve the quality of decision-making.

Responsibilities

• Analyze and interpret Medicare and Medi-Cal data to support Medicare operations, sales, and enrollment functions.
• Conduct complex research and analysis to inform operational decisions and support departmental initiatives.
• Review monthly membership reports, identify trends and discrepancies, and provide insights into enrollment performance and reconciliation.
• Apply relevant Centers for Medicare & Medicaid Services (CMS) guidelines and applicable state and federal regulations to Medicare sales and enrollment activities.
• Serve as a subject matter expert and liaison for internal teams and external stakeholders on Medicare operations matters.
• Support the development and implementation of projects, systems, programs, policies, and procedures.
• Manage multiple projects and competing priorities while meeting deadlines and adapting to changing operational requirements.
• Communicate analytical findings and recommendations clearly to support informed decisions and continuous improvement.

Qualifications

• A bachelor's degree in Business Administration, Healthcare Administration, Public Health, or a related field.
• At least five years of progressively responsible experience in Medicare membership operations, enrollment eligibility, or a closely related area.
• Knowledge of CMS guidelines governing Medicare sales and enrollment.
• Understanding of Medicare Advantage enrollment processes and financial reconciliation.
• Familiarity with monthly membership reports and the ability to interpret membership data accurately.
• Experience with research, data analysis, reporting methodologies, databases, and relevant data analysis tools.
• Familiarity with CRM and enrollment systems; experience with Medicare enrollment platforms such as MarketProminence is relevant.
• Strong analytical and problem-solving skills, including the ability to evaluate complex datasets, identify issues, draw sound conclusions, and recommend action.
• Ability to interpret, explain, and apply relevant policies, laws, codes, regulations, and contracts.
• Strong organizational and project management skills, including prioritization, multitasking, and meeting deadlines.
• Effective communication and stakeholder management skills, with the ability to explain complex findings and serve as a reliable subject matter resource.
• Must be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer-sponsored visa support.
• The role is listed as remote within California.
• The applicable pay zone depends on the work location and local labor costs. final pay depends on qualifications, experience, education, training, internal equity, market factors, and location.

Benefits

• Medical, dental, and vision: Health coverage options for eligible employees.
• Ample paid time off to support rest and personal commitments.
• Paid holidays: 12 holidays per year.
• Retirement savings: Access to a 401(a) retirement plan and a 457 deferred compensation plan.
• Some benefits may be prorated for part-time employees, and these benefits are not available to temporary employees during their assignments.

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR).