Senior Medicare Complaints Specialist

Job Description

A bit about this role:

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. These cases often require thoughtful investigation, strong collaboration across departments, and compassionate communication. You will play a crucial role in ensuring member concerns are addressed promptly, accurately, and in compliance with CMS regulations—helping build trust with our members while supporting Devoted’s mission and contributing to star rating improvement efforts.

This position is ideal for someone who is detail-oriented, member-obsessed, and passionate about quality improvement and operational excellence. You’ll also work on complex and escalated cases, contribute to root cause analysis (RCA) reporting, and help drive continuous learning across the team.

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, 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
   

Required skills and experience: 

• 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.

Desired skills and experience:

• 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
   

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Salary range: $26-$30 per hour

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total re