资格与注册经理
Manager, Eligibility & Enrollment
职位描述
关于这个职位：
我们的资格与注册团队是会员体验的入口——我们处理HMO、PPO和特殊需求计划产品中的每一次注册、取消注册、计划变更和追溯调整，并且我们负责使会员信息准确且可审计的CMS交易。作为经理，您将把部门战略转化为日常流程、生产目标和人员分配，确保工作符合CMS要求并按时完成。
您将向资格与注册高级经理汇报，并领导一个由注册/资格专员组成的团队。这是一个需要亲力亲为的操作性领导职位：您将参与队列、数据和升级问题，同时建立团队运行的报告和控制机制。您的成果会直接体现在CMS交易的准确性与时效性、库存老化、质量审计评分以及与注册准确性相关的会员体验指标上。
您的职责和影响包括：
- 管理日常流程、工作队列和交易库存，确保HMO、PPO和SNP产品中的注册、取消注册、计划变更、取消和追溯调整在CMS和内部SLA内完成，保持老化和积压在设定的阈值内。
- 监控CMS MARx提交、响应和回复文件及错误报告，确保拒绝和差异在规定时间内被研究和解决，每月会员对账准确且及时。
- 作为复杂和例外情况的第一级升级点，根据CMS指导和内部政策做出符合要求的个案决策。
- 监督、辅导和发展专员——招聘、入职、排班、一对一沟通、绩效管理以及与部门KPI挂钩的个人生产和质量目标，并负责团队的生产力、质量、参与度和留存率。您将树立问责和服务卓越的基调，并及时且一致地处理绩效或行为问题。
- 规划高峰期周期（包括AEP、OEP和特殊选举期）的容量和覆盖，防止流量激增导致积压。
- 执行并记录交易和会员记录的质量审查，依据CMS Medicare管理护理注册和取消注册指南及内部控制进行，并推动个人和团队的审计评分。
- 支持CMS、内部和外部
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Job Description
A bit about this role:
Our Eligibility & Enrollment team is the front door to the member experience — we process every enrollment, disenrollment, plan change, and retroactive adjustment across our HMO, PPO, and Special Needs Plan products, and we own the CMS transactions that make membership accurate and auditable. As Manager, you'll turn departmental strategy into daily workflows, production targets, and staff assignments, keeping the work compliant with CMS requirements and on time.
You'll report to the Senior Manager, Eligibility & Enrollment and lead a team of Enrollment/Eligibility Associates. This is a hands-on operational leadership role: you'll be in the queues, in the data, and in the escalations, while building the reporting and controls the team runs on. Your results show up directly in CMS transaction accuracy and timeliness, inventory aging, quality audit scores, and the member experience measures tied to enrollment accuracy.
Your responsibilities and impact will include:
- Managing daily workflow, work queues, and transaction inventory so enrollments, disenrollments, plan changes, cancellations, and retroactive adjustments across HMO, PPO, and SNP products clear within CMS and internal SLAs, holding aging and backlog inside established thresholds.
- Monitoring CMS MARx submissions, response and reply files, and error reports so rejections and discrepancies are researched and resolved inside required timeframes, and membership reconciliation lands accurate and on time each month.
- Serving as the first point of escalation on complex and exception-based cases, making case-level decisions consistent with CMS guidance and internal policy.
- Supervising, coaching, and developing associates — hiring, onboarding, scheduling, one-on-ones, performance management, and individual production and quality goals tied to department KPIs — and owning the team's productivity, quality, engagement, and retention. You'll set the tone for accountability and service excellence, and address performance or conduct issues promptly and consistently.
- Planning capacity and coverage for peak cycles, including AEP, OEP, and Special Election Periods, so volume surges don't become backlog.
- Performing and documenting quality reviews of transactions and member records against the CMS Medicare Managed Care Enrollment and Disenrollment Guidance and internal controls, and driving individual and team audit scores.
- Supporting CMS, internal, and external audits by preparing universes, pulling case files, validating samples, and answering auditor questions; executing assigned corrective action plans and closing them on time, with no repeat findings in your area.
- Translating new CMS guidance and memos into operational changes — recommending workflow updates to the Senior Manager, keeping job aids and desk-level procedures current, and training staff on regulatory changes and system enhancements.
- Identifying recurring errors, rework drivers, and manual workarounds, then implementing process improvements and automation opportunities.
- Building and maintaining notebooks and monitoring views for volume, aging, throughput, accuracy, timeliness, and reconciliation completion, and escalating trends and risks with a recommended action rather than just a number.
- Partnering with peer managers and staff on the design and use of AI agents in transaction processing under a human-in-the-loop model: defining where human review is required, setting quality checkpoints on agent-assisted output, documenting controls to audit standards, and coaching the team against over-reliance on automated output.
- Partnering with Member Services, Billing, Data Reconciliation, Compliance, Sales, Agent Support, and Tech on member-impacting issues, defect resolution, file transmission and interface monitoring, and UAT for configuration changes, upgrades, new products, and plan expansions.
- Supporting the Senior Manager with materials and analysis for leadership, CMS inquiries, and internal governance forums.
Required skills and experience:
- 4+ years in Medicare Advantage eligibility and enrollment operations, including at least 2 years in a supervisory or team lead role.
- Working knowledge of CMS enrollment and disenrollment regulations for HMO, PPO, and SNP products, including election periods, effective dating, and retroactive processing rules.
- Hands-on experience with CMS MARx transaction processing, response and reply file handling, and membership reconciliation.
- Experience supporting CMS or internal audits, including universe preparation and case documentation.
- Strong analytical and root-cause problem-solving skills on complex transaction and eligibility discrepancies, with proficiency in Excel and reporting tools for inventory tracking, trend analysis, and audit sampling.
- Demonstrated aptitude for hands-on operational tooling — including the ability to learn and build notebooks for metric monitoring and reporting — and willingness to work directly in AI-assisted processes under a human-in-the-loop model.
- Effective written and verbal communication, with the ability to explain regulatory requirements to staff and non-technical partners.
- Proven ability to manage competing priorities and high-volume workloads in a deadline-driven, regulated environment, with a demonstrated commitment to data accuracy and member confidentiality (HIPAA).
- Bachelor's degree in Business, Health Administration, or a related field. An equivalent combination of education and directly relevant Medicare enrollment experience will be considered.
- Ability to work remotely with availability to support extended coverage during AEP, OEP, and other peak enrollment periods.
Desired skills and experience:
- Health plan, MSO, or TPA experience, with proficiency in a health plan administration platform (QNXT, Facets, HealthEdge, or similar) and CMS data exchange tools including HPMS.
- Experience designing or overseeing AI agents in an operational workflow; master's degree (MBA, MHA, or similar)
Salary range: $73,000 - $114,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
- 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; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
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.
Originally posted on Himalayas