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Salary: USD 70,000 - 85,000 / annual
Devoted Health is seeking a Senior Associate for the Membership Operations team to manage retroactive enrollment and payment corrections—a critical function that ensures data integrity across the entire health plan. Retroactive corrections touch enrollment, claims, pharmacy, and premium billing simultaneously, and this role is central to getting them right.
You will research and resolve escalated, complex retroactive transaction work by applying CMS guidance, established procedures, and professional judgment. You'll work across the organization to address problems where members' enrollment records are incorrect (wrong plan, county, effective date, subsidy status, or missing entirely).
Key responsibilities include:
- Researching escalated retroactive cases and coordinating solutions across enrollment, claims, pharmacy, and billing teams
- Building durable, self-serve tooling (playbooks, intake forms, readiness trackers, adoption dashboards) to replace manual processes
- Processing transactions through MARx, the MAPD Help Desk, and eRPT (for older effective dates)
- Monitoring case aging and prioritizing work by risk of aging out of favorable categories
- Tracking and reporting on category mix, detection latency, aging, and slippage; escalating capacity constraints early
- Coordinating downstream remediation: claims re-adjudication, pharmacy support, premium adjustments, subsidy corrections, prescription drug event corrections, ID card reissuance, and member/provider notification
- Serving as a knowledgeable escalation point for complex member situations
- Maintaining compliance with federal and state laws, CMS policy, and contract standards
- Analyzing non-compliant trends and collaborating with Enrollment, Sales Compliance, Product, and Engineering to prevent retroactive corrections upstream
- Maintaining complete, audit-ready records of all retroactive cases
This is a fast-paced, high-growth environment where you'll work virtually as part of a collaborative team. You'll need to relate openly with diverse stakeholders and bring compassion for the healthcare challenges facing Medicare beneficiaries.
Required Skills and Experience:
- 3–5 years of healthcare experience, or direct experience with Medicare or Medicaid requirements
- Working proficiency with data tools (spreadsheets minimum; SQL or similar query experience strongly preferred)
- Experience writing business requirements or partnering with technical teams on operational tooling (a plus)
- Self-motivated, flexible, and comfortable collaborating in a virtual, high-growth environment
- Entrepreneurial and proactive mindset
- Ability to learn and stay current on Medicare initiatives
Desired Skills and Experience:
- Direct experience with retroactive enrollment and payment corrections, including RPC submissions and MARx transaction processing
- Familiarity with CMS reply and membership reporting, complaint tracking, and grievance processes
