Senior Membership Operations Associate – Retroactivity

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate escalated and intricate retroactive transaction tasks utilizing CMS guidelines, established procedures, and professional judgment.

• Develop repeatable, self-service operational tools, such as playbooks, intake forms, readiness trackers, and adoption dashboards.

• Prepare and submit transactions through MARx, the MAPD Help Desk, and eRPT for the relevant effective dates.

• Monitor case aging against category limits and prioritize tasks based on risk assessment.

• Track and report on category mix, detection latency, aging, and slippage; escalate any capacity issues.

• Coordinate downstream remediation efforts, including claims re-adjudication, pharmacy support, premium adjustments and refunds, subsidy and penalty corrections, prescription drug event corrections, reissuance of materials and ID cards, and notifications to members and providers.

• Act as an informed point of contact for escalated member cases involving retroactive corrections.

• Analyze business impacts, requirements, and recommend actions in accordance with applicable federal and state laws, regulations, CMS policy guidance, and contractual standards.

• Monitor trends and root causes of non-compliance and collaborate with Enrollment, Sales Compliance, Agent Oversight, Product, and Engineering to address upstream issues.

• Maintain comprehensive and reconstructable records of retroactive cases for auditing, data validation, and annual readiness purposes.

• Represent the Membership Operations team when engaging with various groups of individuals.

⛳️ Requirements

• Capable of thriving in a startup, fast-paced atmosphere.

• 3-5 years of experience in healthcare or familiarity with Medicare or Medicaid requirements.

• Proficient in data tools—at a minimum, spreadsheets; experience with SQL or a similar querying language is highly advantageous.

• Experience in writing business requirements or collaborating with technical teams on operational tools is a plus.

• Self-driven, with a willingness and adaptability to work with colleagues in a virtual setting as a team player.

• Entrepreneurial, proactive, and adaptable, comfortable in a high-growth environment, with the ability to work across the organization independently.

• Compassionate towards the healthcare challenges faced by the Medicare population.

• Committed to continuous learning and staying updated on Medicare initiatives in the market.

• Direct experience with retroactive enrollment and payment corrections is strongly preferred, including RPC submissions and MARx transaction processing.

• Familiarity with CMS responses, membership reporting, complaint tracking, and grievance processes.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.

• Generous paid time off policy.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available to all employees.

• Bonus eligibility for all positions, excluding Director and above.

• Parental leave program.

• 401K program.