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
• Handle complex or highly escalated cases with professionalism and empathy
• Conduct root cause analyses and compile data for reporting to improve operational and member experience

Required Qualifications

• 3+ years of experience in Medicare Advantage, specifically in complaints, appeals, or grievances
• Familiarity with CMS Chapter 2 and Chapter 3 guidelines
• Experience with tracking systems and internal databases
• Strong organizational skills and ability to manage workload across multiple objectives
• Bachelor's degree or equivalent experience in healthcare or a related field is preferred