Remote Medicare Operations & Data Insights Analyst

Jobgether; United States; Remote; USD 82,000 - 95,000; Full time

Benefits offered by this job

Health coverage options

Paid time off

Paid holidays

401(a) retirement plan

457 deferred compensation plan

Wellness program

EV charging stations

Job summary

Jobgether in the United States is seeking an experienced Medicare Operations Analyst to analyze Medicare and Medi-Cal data, ensure regulatory compliance, and drive enrollment efficiency. You will interpret membership trends, support sales and operations, and collaborate with internal teams and external stakeholders to implement improvements.

Within this role, you will apply CMS guidelines, manage multiple projects, and translate complex data into actionable recommendations.

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.
• A master’s degree may substitute for two years of the required experience. An equivalent combination of education and experience may also qualify.
• 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.
• Work authorization: Must be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer-sponsored visa support.

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 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.
• Identify operational issues, investigate their causes, evaluate available information, and recommend appropriate corrective actions.
• Support the development and implementation of projects, systems, programs, policies, and procedures.
• Develop and improve operational workflows to enhance accuracy, efficiency, and consistency across Medicare processes.
• 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.

Skills

Medicare data analysis

Regulatory interpretation

Stakeholder management

Project management

Analytical thinking

Communication skills

CRM systems

Data reporting

Education

Bachelor's degree

Master’s degree preferred

Tools

MarketProminence

CRM software

Database/query tools

Job description

Jobgether in the United States is seeking an experienced Medicare Operations Analyst to analyze Medicare and Medi-Cal data, ensure regulatory compliance, and drive enrollment efficiency. You will interpret membership trends, support sales and operations, and collaborate with internal teams and external stakeholders to implement improvements.

Within this role, you will apply CMS guidelines, manage multiple projects, and translate complex data into actionable recommendations.