Membership Operations Specialist

Waltham, MA /
Operations /
A bit about us: 

We’re on a mission to change healthcare — how it’s paid for, delivered, experienced. We want to put people center stage, not process or profit. We are guided by a deep belief that every person on Medicare should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. 

That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of healthcare company — one that combines compassion, health insurance, clinical care, and technology seamlessly. 

We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.

A bit more about this role:

The Membership Operations specialist works collaboratively with the team to execute the day-to-day business processes required to support the delivery of critical health services: enrollment, membership maintenance, and financial transactions impacting Devoted Health members. In this role you will demonstrate compliance with the Center for Medicare and Medicaid Services guidance, Devoted Health policy and Membership Operations procedures/protocols. 

As Membership Operations Specialist, you will collaborate with designated staff from Devoted Product, Engineering, Data Science and Integration teams to develop and enhance solutions to improve processes. As well, you will directly support our internal partners: Marketing, Agent Support, Telesales, Guides, Claims, Provider, Pharmacy and Risk Adjustment. 

Responsibilities will include:

    • Receive and respond to a high volume of incoming requests related to: enrollment, premium/penalty, provider, other health insurance, and demographic status’. 
    • Provide accurate and thorough written responses to inquiries. 
    • Monitor system que(s) to submit timely and accurate transactions to the Center of Medicare and Medicaid Services.
    • Identify and support process improvement technology initiatives. 
    • Validate membership data and status’ are reconciled and align with Center of Medicare and Medicaid Services record by researching and resolving discrepancies. 
    • Respond to complaints and appeals reported directly to CMS or a CMS contractor. 
    • Investigate eligibility issues impacting access to care and ensure compliant resolution. 
    • Assist with audits, including but not limited to: research, case creation, process improvement identification and submission. 
    • Process member surveys/attestations and submit to Center for Medicare and Medicaid Services (CMS).
    • Support enrollment processing activities.

Attributes of Success:

    • Highly organized and detail-driven
    • Compliance-driven; works well in a fast-paced environment with firm deliverables and timeframes
    • Curiosity to recognize process deficiencies, recommend improvements and implement solutions.
    • Flexibility and willingness to change according to business needs
    • Compassion for healthcare challenges facing the Medicare population
    • Ability to accomodate overtime and/or a rotating schedule in accordance with work volume demands. 

Desired skills and experience:

    • Ability to work in a start-up, fast-paced environment 
    • Bachelor’s degree or in the process of obtaining
    • Knowledge of Medicare Operations guidance
    • Demonstrate the ability to achieve short term goals in 4-6 week intervals 
    • Strong communication

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you! 

Devoted is an equal opportunity employer.  We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.