[Remote] Senior Medicare Complaints Specialist at Devoted Health

United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

3+ years of experience in Medicare Advantage, preferred direct involvement in complaints, appeals, or grievances
Familiarity with CMS Chapter 2 and Chapter 3 guidelines
Excellent customer service and conflict resolution skills, particularly in sensitive or high-stakes situations
Strong written and verbal communication skills, with the ability to explain complex issues clearly and compassionately
Comfortable using multiple platforms, tracking systems, and internal databases
Skilled in organizing tasks, managing workload, and allocating time across multiple objectives
Strong organizational skills with a keen attention to detail and accuracy
Ability to work both independently and collaboratively within a fast-paced, deadline-driven environment
Adaptability: Handles changing regulations, priorities, or case volumes with resilience and teamwork

Responsibilities

Research and resolve Medicare-submitted complaints in accordance with CMS guidelines and internal SOPs
Maintain current knowledge of Devoted Health products and benefit offerings
Support a culture of continuous learning and member advocacy, helping Devoted fulfill its mission
Handle complex or highly escalated cases with professionalism and empathy
Communicate with members via phone, email, and written correspondence to resolve complaints and foster trust
Triage complaints to ensure accurate categorization and routing to the appropriate teams
Document all complaint activity with accuracy across multiple systems and platforms
Ensure all CMS complaint timelines and internal SLAs are met
Conduct root cause analyses and help categorize complaints appropriately
Review call history and interactions to identify coaching opportunities and potential systemic issues
Compile RCA data for reporting and contribute to insights that drive operational and member experience improvements
Share learnings, trends, and best practices across internal teams and AHS partners
Participate in team training efforts and support new team members
Contribute to ad hoc projects or process improvement initiatives as needed

Skills

Key technologies and capabilities for this role

CMS regulationsMedicare complaintsRoot Cause AnalysisMember communicationComplaint triageSOP complianceCall reviewRCA reportingOperational excellenceMember advocacy

Questions & Answers

Common questions about this position

What experience is required for the Senior Medicare Complaints Specialist role?

Candidates need 3+ years of experience in Medicare Advantage, preferably with direct involvement in complaints, appeals, or grievances, along with familiarity with CMS Chapter 2 and Chapter 3 guidelines.

What key skills are needed for this position?

The role requires excellent customer service and conflict resolution skills, strong written and verbal communication skills, strong organizational skills with attention to detail, and the ability to work independently and collaboratively in a fast-paced environment.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What is the salary or compensation for this role?

This information is not specified in the job description.

What makes a strong candidate for this Senior Medicare Complaints Specialist position?

A strong candidate is detail-oriented, member-obsessed, passionate about quality improvement and operational excellence, with adaptability to handle changing regulations, priorities, or cases.

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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