Membership Operations Senior Associate - Retroactivity
Core
Execute complex retroactive corrections for member enrollment, payment, and claims data integrity across Medicare/Medicaid plans.
Role type
Senior Associate, Membership Operations (Retroactivity)
Builds
Durable self-serve tooling (playbooks, intake trackers, dashboards) for transaction processing
Domain
US Healthcare (Medicare/Medicaid) / Health Plan Operations
Deliverable
Production ML models | product features | dashboards & analysis | client delivery
Required skills
Medicare/Medicaid regulatory knowledge, data analysis (SQL/spreadsheets), transaction processing, stakeholder collaboration, root cause analysis
Preferred skills
Retroactive enrollment/payment correction experience, CMS reporting/grievance processes, business requirements writing
Technologies
MARx, MAPD Help Desk, eRPT, SQL
Responsibilities
Research and resolve escalated retroactive transaction issues; submit transactions via internal channels and eRPT; monitor case aging and prioritize by risk; coordinate downstream remediation (claims, pharmacy, premium adjustments); analyze non-compliant trends to prevent upstream gaps; maintain audit-ready records.
Seniority
Mid-level (3-5 years), hands-on IC