Medicare Complaints Coordinator

State of Washington
Full Time, Permanent WA Washington State Office of the Insurance Commissioner, 5000 Capitol Blvd SE, Tumwater, WA 98501, United States Apply before 6/20/2024 11:59


The duties of the position include, but are not limited to: 

  • Receive Medicare-specific complaints regarding fraud, waste, abuse, marketing misrepresentation, enrollment programs - or related - and serves as the liaison with CMS and other agencies to resolve and/or properly refer.
  • Document case work in accordance with state and federal guidelines, in the appropriate databases.
  • Serve as a subject matter expert (SME) and fraud prevention and education specialist. Provide regular reports to the SMP Coordinator and SHIBA Program Manager on numbers, types and resolution status of complaints.
  • Follow-up with consumer inquiries from the SHIBA mailbox and web-site referrals to bring about resolution.
  • Counsel clients one-on-one, on the phone or in the office or via Microsoft Office Teams or Zoom.
  • Help the Medicare Training Coordinator develop training materials regarding a) Medicare fraud, errors and abuse, b) resolving complex cases, c) complaints and related issues.
  • Provide training to Volunteer Coordinators and volunteer advisors regarding these related topics


Required Qualifications:
Six years of professional experience in community development, adult training, or volunteer management
A bachelor’s degree* with focus in business, health care management, health care administration or a related field will substitute for up to 4 years of professional work experience

  • 2 years professional experience in a healthcare administration or office setting with claims, and billing. 
  • 2 years professional experience working with Medicare related claims, billing and/or questions.
  • Demonstrated competence in building collaborative relationships with professional colleagues.
  • Working knowledge of project management, contract management and/or instructional design.
  • Intermediate competency level using Microsoft Outlook, Word, PowerPoint and Excel
  • Intermediate technical competency level using at least one virtual platform (e.g. Zoom, Teams, Skype). 
  • Demonstrated skill in creating, hosting, and troubleshooting technical challenges.  Ability to use various tools and resources within the platform to engage audience.
* If a degree or other credentials are listed, proof will be required prior to employment. University degrees must be recognized by the U.S. Department of Education and the Council for Higher Education Accreditation (CHEA) or foreign equivalent. If a degree was awarded outside the United States, candidates must provide a credential evaluation report.

  • Demonstrated contributions to building a high-performing team of professional colleagues.
  • Experience developing partnerships with diverse communities.