Senior Medicare Complaints Specialist (Healthcare)

TL;DR

Senior Medicare Complaints Specialist (Healthcare): Resolving complaints submitted to Medicare by members with an accent on CMS regulation compliance and root cause analysis. Focus on investigating complex cases, improving star ratings, and fostering member trust through compassionate communication.

Location: Remote (USA)

Salary: $26–$30 per hour

Company

An all-in-one healthcare company combining insurance, clinical care, and technology to improve the well-being of older Americans.

What you will do

• Research and resolve Medicare-submitted complaints following CMS guidelines and internal SOPs.
• Handle complex and highly escalated cases with professionalism and empathy.
• Conduct root cause analyses (RCA) to identify systemic issues and drive operational improvements.
• Communicate with members via phone, email, and writing to resolve concerns and build trust.
• Triage complaints for accurate categorization and routing to appropriate teams.
• Participate in team training and support new team members.

Requirements

• 3+ years of experience in Medicare Advantage, specifically with complaints, appeals, or grievances.
• Familiarity with CMS Chapter 2 and Chapter 3 guidelines.
• Must be based in the USA.
• Excellent customer service and conflict resolution skills for high-stakes situations.
• Strong written and verbal communication skills.
• Ability to work in a fast-paced, deadline-driven environment.

Nice to have

• Bachelor’s degree in healthcare, public health, or a related field.
• Experience with CMS submissions and CTM documentation.
• Knowledge of health insurance products and claims processing.
• Familiarity with RCA methodologies and reporting best practices.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and parental leave program.
• Stock options for all employees and bonus eligibility.
• $100 monthly mobile or internet stipend.
• 401K program.