Senior Membership Operations Specialist – Data Integrity

Devoted Health; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

Devoted Health is seeking a Senior Associate to join the Membership Operations team, where you will safeguard the integrity of members' data critical to health plan operations. The role covers SNP eligibility validation, Enrollment, Member Data Integrity, and other related functions.

You will address retroactive enrollment issues, help build durable tooling, and coordinate downstream remediation to keep members whole. This position emphasizes cross-functional collaboration and data accuracy.

Responsibilities

• Research 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; el…
• 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

Job description

Devoted Health is seeking a Senior Associate to join the Membership Operations team, where you will safeguard the integrity of members' data critical to health plan operations. The role covers SNP eligibility validation, Enrollment, Member Data Integrity, and other related functions.

You will address retroactive enrollment issues, help build durable tooling, and coordinate downstream remediation to keep members whole. This position emphasizes cross-functional collaboration and data accuracy.