Director of Membership Operations

Job Summary

To enhance member experience, the full-time remote Director of Membership Status Operations will manage end-to-end operations for member status determinations, oversee reconciliation and controls, and ensure compliance with regulatory standards while utilizing AI tools for efficiency.

Key responsibilities

• Own the complete operation for member status determinations, ensuring accurate identification and resolution of issues
• Define and deliver KPIs for operational performance, including detection coverage and payment accuracy
• Collaborate with cross-functional teams to maintain compliance with CMS regulations and improve operational workflows

Required qualifications

• Proven experience in developing scalable operational processes and controls
• Demonstrated ability to manage cross-functional initiatives from conception to execution
• Fluency in data analysis and the ability to derive insights independently
• Experience in Medicare Advantage or related regulatory environments
• Strong ethical standards and decision-making skills under pressure