Senior Membership Operations Associate – Retroactivity

Devoted Health

. Research escalated and complex retroactive transaction work using CMS guidance, established procedures, and professional judgment .

Posted 9/16/2026full-timeRemote • United StatesSenior💰 $70,000 - $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in retroactive transaction processing, including MARx transaction submissions and compliance with Medicare and Medicaid requirements. Proficient in data analysis and operational tooling development, with a strong focus on collaboration and problem-solving in a fast-paced healthcare environment.

Highest-signal resume keywords

MARx Transaction ProcessingRetroactive Enrollment CorrectionsData Analysis with SQLHealthcare Compliance KnowledgeOperational Tooling Development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisSQLBusiness Requirements WritingOperational ToolingTransaction ProcessingRetroactive CorrectionsCMS Policy GuidanceAudit Record MaintenanceCase MonitoringRisk Prioritization

Soft Skills

Self-MotivatedCollaborativeProactiveFlexibleCompassionate

Tools & Technologies

SpreadsheetsMARxERPTMAPD Help DeskIntake TrackersReadiness TrackersAdoption Dashboards

Industry Keywords

MedicareMedicaidCMSEnrollmentClaims Re-AdjudicationPremium AdjustmentsSubsidy CorrectionsGrievance ProcessesMember NotificationProvider Notification

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Research escalated and complex retroactive transaction work using CMS guidance, established procedures, and professional judgment
Build repeatable, self-serve operational tooling, including playbooks, intake, readiness trackers, and adoption dashboards
Prepare and submit transactions through MARx, the MAPD Help Desk, and eRPT for applicable effective dates
Monitor case aging against category boundaries and prioritize work based on risk
Track and report category mix, detection latency, aging, and slippage; escalate capacity constraints
Coordinate downstream remediation including 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
Analyze business impacts, requirements, and recommended actions under applicable federal and state laws, regulations, CMS policy guidance, and contract standards
Monitor non-compliant trends and root causes and collaborate with Enrollment, Sales Compliance, Agent oversight, Product, and Engineering to correct upstream gaps
Maintain complete, reconstructable records of retroactive cases for audit, data validation, and annual readiness
Represent the Membership Operations team when relating with diverse groups of people

Requirements

What you’ll need

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
Direct experience with retroactive enrollment and payment corrections strongly preferred, including RPC submissions and MARx transaction processing
Familiarity with CMS reply and membership reporting, complaint tracking, and grievance processes

Benefits

Comp & perks

Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above
Parental leave program
401K program