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Salary: USD 73,000 - 114,000 / annual
Devoted Health is seeking a Manager, Eligibility & Enrollment to lead operational execution of Medicare Advantage enrollment, disenrollment, plan changes, and retroactive adjustments across HMO, PPO, and Special Needs Plan products. You will report to the Senior Manager, Eligibility & Enrollment and supervise a team of Enrollment/Eligibility Associates.
In this hands-on operational leadership role, you will manage daily workflow, work queues, and transaction inventory to ensure enrollments, disenrollments, plan changes, and retroactive adjustments clear within CMS and internal SLAs. You'll monitor CMS MARx submissions, response and reply files, and error reports to research and resolve rejections and discrepancies within required timeframes. You'll serve as the first point of escalation on complex and exception-based cases, making decisions consistent with CMS guidance and internal policy.
You will supervise and develop associates through hiring, onboarding, scheduling, one-on-ones, performance management, and individual production and quality goals tied to department KPIs. You'll own the team's productivity, quality, engagement, and retention, setting the tone for accountability and service excellence.
Additional responsibilities include planning capacity and coverage for peak cycles (AEP, OEP, Special Election Periods), performing quality reviews of transactions and member records against CMS Medicare Managed Care Enrollment and Disenrollment Guidance, supporting CMS and internal audits, translating new CMS guidance into operational changes, identifying process improvement and automation opportunities, building monitoring dashboards for volume, aging, throughput, accuracy, and timeliness, and partnering with peer managers on AI agent implementation under a human-in-the-loop model. You'll also collaborate with Member Services, Billing, Data Reconciliation, Compliance, Sales, Agent Support, and Tech on member-impacting issues and system changes.
Your results directly impact CMS transaction accuracy and timeliness, inventory aging, quality audit scores, and member experience measures tied to enrollment accuracy.
REQUIREMENTS:
- 4+ years in Medicare Advantage eligibility and enrollment operations, including at least 2 years in a supervisory or team lead role
- Working knowledge of CMS enrollment and disenrollment regulations for HMO, PPO, and SNP products, including election periods, effective dating, and retroactive processing rules
- Hands-on experience with CMS MARx transaction processing, response and reply file handling, and membership reconciliation
- Experience supporting CMS or internal audits, including universe preparation and case documentation
- Strong analytical and root-cause problem-solving skills on complex transaction and eligibility discrepancies
- Proficiency in Excel and reporting tools for inventory tracking, trend analysis, and audit sampling
- Demonstrated aptitude for hands-on operational tooling, including ability to learn and build notebooks for metric monitoring and reporting
- Willingness to work directly in AI-assisted processes under a human-in-the-loop model
- Effective written and verbal communication, with ability to explain regulatory requirements to staff and non-technical partners
- Proven ability to manage competing priorities and high-volume workloads in a deadline-driven, regulated environment
- Demonstrated commitment to data accuracy and member confidentiality (HIPAA)
- Bachelor's degree in Business, Health Administration, or related field (or equivalent combination of education and directly relevant Medicare enrollment experience)
- Ability to work remotely with availability to support extended coverage during AEP, OEP, and other peak enrollment periods
DESIRED:
- Health plan, MSO, or TPA experience
- Proficiency in health plan administration platform (QNXT, Facets, HealthEdge, or similar)
- CMS data exchange tools including HPMS
- Experience designing or overseeing AI agents in operational workflow
- Master's degree (MBA, MHA, or similar)
