Senior Medicare Complaints Specialist

United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates should have at least 3 years of experience in Medicare Advantage, with a preference for direct involvement in complaints, appeals, or grievances. Familiarity with CMS Chapter 2 and Chapter 3 guidelines is required, along with excellent customer service and conflict resolution skills, especially in sensitive situations. Strong written and verbal communication abilities are necessary to explain complex issues clearly and compassionately. Candidates must be comfortable using multiple platforms and tracking systems, possess strong organizational skills with attention to detail, and be able to work independently and collaboratively in a fast-paced environment. Adaptability to changing regulations and priorities is also essential.

Responsibilities

The Senior Medicare Complaints Specialist will research and resolve Medicare-submitted complaints in accordance with CMS guidelines and internal SOPs, maintaining knowledge of Devoted Health products and benefits. They will handle complex or escalated cases with professionalism, communicate with members via phone, email, and written correspondence, and triage complaints for accurate routing. Responsibilities include documenting all complaint activity, ensuring CMS complaint timelines and internal SLAs are met, and conducting root cause analyses. The role involves compiling RCA data for reporting, identifying coaching opportunities, sharing learnings with internal teams, participating in training, and contributing to ad hoc projects or process improvement initiatives.

Skills

Medicare

Complaints Resolution

CMS Regulations

Root Cause Analysis

Member Advocacy

Communication

Research

Problem-Solving

Detail-Oriented

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

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