Medicare Operations Analyst

Accountabilities:

Reporting to the Medicare Operations Director, you will provide analytical and operational support across Medicare activities, helping strengthen enrollment processes, maintain regulatory compliance, and improve the quality of decision-making.

• Analyze and interpret Medicare and Medi-Cal data to support Medicare operations, sales, and enrollment functions.

• Conduct complex research and analysis to inform operational decisions and support departmental initiatives.

• Review monthly membership reports, identify trends and discrepancies, and provide insights into enrollment performance and reconciliation.

• Apply relevant Centers for Medicare & Medicaid Services (CMS) guidelines and applicable state and federal regulations to Medicare sales and enrollment activities.

• Serve as a subject matter expert and liaison for internal teams and external stakeholders on Medicare operations matters.

• Identify operational issues, investigate their causes, evaluate available information, and recommend appropriate corrective actions.

• Support the development and implementation of projects, systems, programs, policies, and procedures.

• Develop and improve operational workflows to enhance accuracy, efficiency, and consistency across Medicare processes.

• Manage multiple projects and competing priorities while meeting deadlines and adapting to changing operational requirements.

• Communicate analytical findings and recommendations clearly to support informed decisions and continuous improvement.

Requirements:

You bring a strong understanding of Medicare membership operations and enrollment eligibility, along with the analytical skills needed to interpret complex data and translate findings into effective operational recommendations. You are organized, adaptable, and comfortable applying regulatory requirements while collaborating with stakeholders across different functions.

• A bachelor’s degree in Business Administration, Healthcare Administration, Public Health, or a related field.

• At least five years of progressively responsible experience in Medicare membership operations, enrollment eligibility, or a closely related area.

• A master’s degree may substitute for two years of the required experience. An equivalent combination of education and experience may also qualify.

• Knowledge of CMS guidelines governing Medicare sales and enrollment.

• Understanding of Medicare Advantage enrollment processes and financial reconciliation.

• Familiarity with monthly membership reports and the ability to interpret membership data accurately.

• Experience with research, data analysis, reporting methodologies, databases, and relevant data analysis tools.

• Familiarity with CRM and enrollment systems; experience with Medicare enrollment platforms such as MarketProminence is relevant.

• Strong analytical and problem-solving skills, including the ability to evaluate complex datasets, identify issues, draw sound conclusions, and recommend action.

• Ability to interpret, explain, and apply relevant policies, laws, codes, regulations, and contracts.

• Strong organizational and project management skills, including prioritization, multitasking, and meeting deadlines.

• Effective communication and stakeholder management skills, with the ability to explain complex findings and serve as a reliable subject matter resource.

• Work authorization: Must be currently authorized to work in the United States on a full-time, ongoing basis without current or future employer-sponsored visa support.

• Location preference: Candidates living in or near Santa Cruz, Monterey, Merced, San Benito, or Mariposa counties are preferred. The role is listed as remote within California.

Benefits:

• Annual base salary — Zone 1: $82,000–$95,000 for typical locations including Santa Cruz, San Benito, and Monterey counties, the Bay Area, Sacramento, Los Angeles, and San Diego.

• Annual base salary — Zone 2: $77,000–$90,000 for typical locations including Mariposa and Merced counties, Fresno, Bakersfield, Eastern California, San Luis Obispo, and the Central Valley outside Sacramento.

• Location-based compensation: The applicable pay zone depends on the work location and local labor costs. The listed hiring ranges are good-faith estimates rather than the full compensation ranges; final pay depends on qualifications, experience, education, training, internal equity, market factors, and location.

• Medical, dental, and vision: Health coverage options for eligible employees.

• Paid time off: Ample paid time off to support rest and personal commitments.

• Paid holidays: 12 holidays per year.

• Retirement savings: Access to a 401(a) retirement plan and a 457 deferred compensation plan.

• Health and wellness: A comprehensive health and wellness program.

• Onsite amenities: Electric vehicle charging stations.

• Eligibility: Benefits are available to regular employees working more than 30 hours per week. Some benefits may be prorated for part-time employees, and these benefits are not available to temporary employees during their assignments.