Membership Operations Senior Associate - Retroactivity

devoted; United States; On-site; USD 70,000 - 85,000; Full time

Benefits offered by this job

Health, dental & vision coverage

Paid time off

Monthly mobile/internet stipend

Stock options

Job summary

Devoted Health is seeking a Senior Associate for the Membership Operations team to manage retroactive corrections across enrollment, payments, and billing. You will drive data integrity and coordinate remediation to keep member records accurate and compliant.

The role requires healthcare or Medicare experience, proficiency with data tools, and the ability to collaborate across Enrollment, Compliance, Product, and Engineering in a fast-paced startup environment.

Qualifications

• 3–5 years of healthcare experience or Medicare/Medicaid knowledge.
• Working proficiency with data tools and SQL.
• Experience writing business requirements or partnering with technical teams.
• Self-motivated and able to collaborate in a virtual environment.
• Entrepreneurial, proactive and flexible in a high-growth setting.
• Compassion for healthcare challenges facing the Medicare population.
• Ability to learn and stay current on Medicare initiatives.

Responsibilities

• Research escalated and complex retroactive transactions using CMS guidance and procedures.
• Build durable, self-serve tooling: playbooks, intake trackers, adoption dashboards.
• Prepare and submit transactions through MARx, MAPD Help Desk, and RPC for older dates.
• Monitor case aging and prioritize work by risk.
• Track category mix, detection latency, aging, and slippage; flag capacity constraints.
• Coordinate downstream remediation: claims re-adjudication, premium adjustments, refunds.
• Serve as a knowledge contact for escalated retroactive corrections.
• Maintain compliance with federal/state laws, CMS guidance, and contracts.
• Analyze non-compliant trends and collaborate to correct upstream gaps.

Skills

Startup environment

Healthcare experience

SQL

Data tools

Business requirements

Virtual collaboration

Entrepreneurial mindset

Adaptability

Medicare knowledge

Tools

MARx

MAPD Help Desk

eRPT

Job description

Job Description

A bit about this role:

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. The team includes SNP eligibility validation, Enrollment, Member Data Integrity, Member Financial Integrity, Member and Payment Reconciliation, Quality Management, and 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: You will address problems by drawing on CMS guidance, established procedures, and professional judgment, while leveraging resources across the organization to gain input.
• Assist in building the tooling that makes change repeatable: Playbooks, intake, readiness trackers, adoption dashboards. Anything we repeat should run as durable, self-serve tooling, not a manual doc.
• 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 rather than by simple queue order
• Track and report on category mix, detection latency, aging, and slippage; elevate 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; conduct business-specific analysis and communicate business impacts, requirements, and recommended actions
• Monitor and analyze non-compliant trends and root causes, and collaborate with stakeholders - Enrollment, Sales Compliance, Agent oversight, Product, and Engineering - to correct upstream gaps so the retroactive correction is not needed next time
• 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

Required skills and experience:

• 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

Desired skills and experience:

• 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

Salary:

Salary: $70,000 - $85, 000 annually

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock op