Membership Operations Senior Associate – Retroactivity

About This Opportunity

We are representing a confidential Medicare health plan in their search for a Membership Operations Senior Associate – Retroactivity. This is a remote position based in the United States.

This role sits at the center of member data integrity—the foundation that drives enrollment accuracy, payment reconciliation, claims processing, and member experience. When enrollment records need correction (wrong plan, county, effective date, or subsidy status), you'll manage the complex retroactive work that touches every part of the health plan simultaneously.

Responsibilities

• Research and resolve escalated retroactive transaction cases by applying CMS guidance, internal procedures, and professional judgment
• Prepare and submit transactions through internal systems and CMS portals for current and prior-period effective date corrections
• Build repeatable operational tooling: playbooks, intake forms, readiness trackers, and adoption dashboards that turn manual processes into scalable workflows
• Monitor case aging against CMS category boundaries and prioritize work by compliance risk rather than simple queue order
• Track and report on category mix, detection latency, aging trends, and slippage; escalate capacity issues proactively
• Coordinate downstream remediation including claims re-adjudication, pharmacy support, premium adjustments, subsidy corrections, and member communications
• Serve as an escalation point for complex member situations involving retroactive corrections
• Analyze non-compliant trends and root causes; partner with enrollment, sales compliance, product, and engineering teams to prevent future issues
• Maintain complete audit-ready case documentation to support data validation and annual readiness reviews

What We're Looking For

Required:

• 3–5 years of experience in healthcare, Medicare, or Medicaid operations
• Working proficiency with data tools—advanced spreadsheet skills at minimum; SQL or query experience strongly preferred
• Ability to thrive in a fast-paced, high-growth environment
• Self-motivated and collaborative, comfortable working in a remote team setting
• Understanding of federal and state healthcare regulations, CMS policy guidance, and contract standards
• Compassion for the healthcare challenges facing the Medicare population

Strongly Preferred:

• Direct experience with retroactive enrollment and payment corrections, including RPC submissions and transaction processing through CMS systems
• Familiarity with CMS reply and membership reporting, complaint tracking, and grievance processes
• Experience writing business requirements or partnering with technical teams on operational tooling

How We Work With You

Candidates apply directly through Get A Job.ai. Our recruiting team will conduct an initial screening and coordinate your interview process with the client. Once we submit your profile, the client will handle interviews and final selection. Please apply exclusively through our platform—direct contact with the client is not part of this process.

Pay

The client's posted salary range for this role is $70,000–$85,000 annually. Final compensation depends on qualifications, experience, skills, education, and location. The client offers a comprehensive benefits package including employer-sponsored health coverage, generous PTO, mobile/internet stipend, equity, bonus eligibility, parental leave, and 401K.

Get A Job.ai is an equal opportunity employer. We welcome applicants of all backgrounds and do not discriminate on the basis of race, color, religion, sex, national origin, disability, age, sexual orientation, veteran status, gender identity, or any other protected characteristic.