Medicare Operations Analyst

As a Medicare Operations Analyst, you will support critical Medicare operations, sales, and enrollment activities through detailed data analysis, research, and regulatory interpretation. You will help ensure accurate membership reporting and compliance with applicable state and federal requirements while identifying opportunities to improve operational performance. Working closely with internal teams and external stakeholders, you will translate complex data into actionable insights and practical recommendations. Your expertise will contribute to effective enrollment processes, reliable reporting, and well-informed business decisions. You will also help develop and refine operational workflows, systems, and procedures in a mission-driven healthcare environment. This remote opportunity is particularly suited to candidates based in or near the communities served across California’s Central Coast and surrounding counties.

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.