Member Service Guide – Complaint Resolution

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $22 - $25 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 23 days.

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Maintain current knowledge of Devoted Health products, benefits, policies, and procedures • Conduct thorough investigations of member grievances by reviewing case details, records, and relevant policies • Independently resolve most grievances and determine appropriate solutions across multiple systems • Recommend practical solutions, connect members with Devoted programs and resources, and minimize member effort • Escalate complex situations when additional expertise is needed • Triage and route grievances accurately • Communicate with members through written correspondence and telephone contact while meeting regulatory requirements • Adapt communication to member needs, clarify information, and confirm next steps • Complete accurate documentation and data entry across multiple systems • Resolve grievances within regulatory and departmental timelines • Manage workload and adjust priorities based on volume and complexity • Collaborate with internal partners and teammates to gather information and resolve cases • Identify process and member-experience improvement opportunities • Seek feedback and adapt to changes in workflows, tools, and priorities • Flex into other teams’ work during non-peak periods as business priorities evolve

🎯 Requirements

• Experience with Medicare Advantage appeals and grievances • Strong attention to detail and commitment to data accuracy • Adaptability to changing regulations, priorities, or case volumes • Excellent customer service and conflict resolution skills, particularly when interacting with frustrated or vulnerable members • Strong time management and organizational skills • Ability to work independently and as part of a collaborative team • Strong written and verbal communication skills • Ability to obtain and maintain access to the CMS Health Plan Management System (HPMS), including required access, security, and training steps • Working knowledge of insurance products, policies, procedures, and claims processes • Superior investigative, analytical, and problem-solving skills • Experience escalating cases and collaborating with internal stakeholders • Strong computer and documentation skills with comfort using multiple platforms • Bachelor’s degree or equivalent experience is desired in healthcare, conflict resolution, or a related field • Five-day-a-week schedule; shift of 8.5 hours including a 30-minute lunch, within 8:00 AM–2:00 AM ET, Monday through Friday • May include rotating weekend coverage, up to one weekend per month, and weekend on-call support

🏖️ 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 • Parental leave program • 401K program

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