Devoted Health · 11 hours ago
Senior Medicare Complaints Specialist
United States
Full-time
Remote
Mid, Senior Level
$26/hr - $30/hr
3+ years expDevoted Health is on a mission to dramatically improve the health and well-being of older Americans. As a Senior Medicare Complaint Specialist, you will be responsible for resolving complaints submitted directly to Medicare, ensuring compliance with CMS regulations, and contributing to quality improvement efforts within the organization.
Elder CareElderlyHealth Care
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
Qualification
Required
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
Preferred
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....
Company
Devoted Health
Devoted Health is a healthcare company serving seniors and giving them a health care plan with personal guides and world-class technology.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$2.26BKey Investors
Andreessen HorowitzVenrock
2024-08-02Series E· $112M
2023-12-29Series E· $175M
2021-10-08Series D· $1.15B
Leadership Team
Todd Park
Co-Founder, Executive Chairman
Adam Baratz
Technologist
Recent News
General Catalyst
2025-12-24
2025-12-03
Venrock
2025-12-03
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