Membership Operations Senior Associate - Retroactivity

A bit about this role:  The Senior Associate, on the Membership Operations team, is a key player within a pivotal function. Devoted Health's Membership Operations team is entrusted with the R&D and operational execution behind the integrity of our members' data — the data that everything else in health plan operations depends on. The team includes SNP eligibility validation, Enrollment, Member Data Integrity, Member Financial Integrity, Member and Payment Reconciliation, Quality Management, and Strategy.  Retroactivity cuts across all of them. When a member's enrollment record is wrong — wrong plan, wrong county, wrong effective date, wrong subsidy status, or missing entirely — the correction is retroactive, and it touches enrollment, payment, claims, pharmacy, and premium billing simultaneously.   Your Responsibilities and Impact will include: Researching 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; escalate capacity constraints before they translate into aged cases 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 in applicable federal and state laws, regulations, CMS policy guidance, and contract standards; conduct business-specific analysis and communicate business impacts, requirements, and recommended actions Monitor and analyze non-compliant trends and root causes, and collaborate with stakeholders — Enrollment, Sales Compliance, Agent oversight, Product, and Engineering — to correct upstream gaps so the retroactive correction is not needed next time Maintain a complete, reconstructable record of retroactive cases sufficient to support audit, data validation, and annual readiness Relate openly and comfortably with a diverse group of people as a representative of the Membership Operations team Required skills and experience:  Ability to work in a startup, fast-paced environment 3-5 years of experience in healthcare, or experience with Medicare or Medicaid requirements  Working proficiency with data tools — spreadsheets at minimum, SQL or similar query experience a strong plus Experience writing business requirements or partnering with technical teams on operational tooling a plus Self-motivated, with the desire and flexibility to collaborate with co-workers in a virtual environment as a team player Entrepreneurial, proactive, and flexible, comfortable in a high-growth environment, with an ability to proactively work across an organization Compassion for the healthcare challenges facing the Medicare population Ability to continue to learn and stay current on Medicare initiatives in the marketplace Desired skills and experience:  Direct experience with retroactive enrollment and payment corrections strongly preferred, including RPC submissions and MARx transaction processing Familiarity with CMS reply and