[Hiring] Senior Medicare Complaints Specialist @Devoted Health

Role Description

As a Senior Medicare Complaint Specialist at Devoted Health, you will serve as a key contributor in resolving complaints submitted directly to Medicare by our members. This position is ideal for someone who is detail-oriented, member-obsessed, and passionate about quality improvement and operational excellence.

Your Responsibilities and Impact will include:

• 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
• 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

Qualifications

• 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

Requirements

• Bachelor’s degree or equivalent experience in healthcare, conflict resolution, public health, or a related field
• Experience working directly with CMS submissions and CTM documentation
• Knowledge of health insurance products, claims processing, and member benefits
• Prior experience identifying operational gaps or trends based on complaint data
• Familiarity with RCA methodologies and reporting best practices
• Experience mentoring peers or participating in training initiatives

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more...