Membership Operations Senior Associate - Retroactivity

Location: Remote USA

Salary: $70,000–$85,000 annually

Company

hirify.global is a healthcare company focused on improving the health and well-being of older Americans through an integrated care platform combining data, AI, clinical services, and member support.

What you will do

• Research escalated and complex retroactive enrollment and payment transactions using CMS guidance, established procedures, and professional judgment.
• Prepare and submit transactions through MARx, the MAPD Help Desk, and RPC via eRPT according to effective-date requirements.
• Build repeatable operational tooling, including playbooks, intake processes, readiness trackers, and adoption dashboards.
• Monitor case aging, category mix, detection latency, slippage, and capacity risks, escalating issues before cases age out of favorable categories.
• Coordinate downstream remediation across claims, pharmacy, premium billing, subsidies, penalties, prescription drug events, member materials, ID cards, and notifications.
• Analyze non-compliant trends and root causes, collaborate with operational and technical stakeholders, and maintain reconstructable records for audits and readiness.

Requirements

• 3–5 years of experience in healthcare or experience with Medicare or Medicaid requirements.
• Working proficiency with spreadsheets; SQL or similar query experience is beneficial.
• Ability to work proactively and collaboratively in a fast-paced, virtual, high-growth environment.
• Ability to stay current on Medicare initiatives, federal and state regulations, CMS guidance, and contract standards.
• Compassion for healthcare challenges affecting the Medicare population and comfort serving as a point of contact for escalated member situations.

Nice to have

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

Culture & Benefits

• Virtual collaboration in a fast-paced, high-growth environment.
• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and a parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options, bonus eligibility, and a 401(k) program for eligible full-time employees.
• Commitment to a safe, supportive, diverse, and collaborative workplace.