Senior Medicare Complaints Specialist

Job Summary

A company is looking for a Senior Medicare Complaints Specialist.

Key Responsibilities

• Research and resolve Medicare-submitted complaints in accordance with CMS guidelines
• Handle complex or escalated cases with professionalism and empathy
• Conduct root cause analyses and contribute to insights for operational 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 related field preferred
• Experience working directly with CMS submissions and documentation
• Ability to manage workload and adapt to changing regulations and priorities