Senior Medicare Complaints Specialist

Job Summary

A company is looking for a Senior Medicare Complaints Specialist to resolve complaints submitted to Medicare by members.

Key Responsibilities

• Research and resolve Medicare-submitted complaints in accordance with CMS guidelines and internal SOPs
• Handle complex or highly escalated cases with professionalism and empathy
• Conduct root cause analyses and contribute to insights that drive operational and member experience improvements

Required Qualifications

• 3+ years of experience in Medicare Advantage, preferably in complaints, appeals, or grievances
• Familiarity with CMS Chapter 2 and Chapter 3 guidelines
• Bachelor's degree or equivalent experience in healthcare or a related field is preferred
• Experience working directly with CMS submissions and documentation
• Strong organizational skills with the ability to manage multiple objectives in a fast-paced environment