Member Service Guide – Complaint Resolution

Devoted Health

. Maintain current knowledge of Devoted Health products, benefits, policies, and procedures .

Posted 11/11/2026full-timeRemote • United StatesMid-LevelSenior💰 $22 - $25 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare Advantage appeals and grievances, with strong investigative, analytical, and problem-solving skills. Proficient in managing member communications and documentation while adhering to regulatory requirements and organizational policies.

Highest-signal resume keywords

Medicare Advantage AppealsGrievance ResolutionCustomer Service SkillsData AccuracyConflict Resolution

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Investigative SkillsAnalytical SkillsProblem-Solving SkillsDocumentation SkillsData Entry SkillsInsurance Policies KnowledgeClaims Processes KnowledgeRegulatory ComplianceTime ManagementOrganizational Skills

Soft Skills

Attention to DetailAdaptabilityCollaborationWritten CommunicationVerbal Communication

Tools & Technologies

CMS Health Plan Management System (HPMS)Multiple Platforms

Industry Keywords

HealthcareMember GrievancesInternal StakeholdersMember Experience ImprovementWorkload Management

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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