Complaint & Clinical Policy Advisor MD Live Hybrid

The Medical Complaint & Clinical Policy Advisor is responsible for the day-to-day operations and continuous improvement of MD Lives medical complaint and clinical policy functions. This role owns the end-to-end medical complaint lifecycleintake investigation service recovery resolution and trend analysisensuring timely high-quality responses and sustainable corrective actions that enhance the patient and provider experience.

The Advisor also supports clinical policy governance across service lines partnering with clinical operational and compliance stakeholders to develop harmonize and maintain evidence-based clinical policies. This role ensures data integrity produces actionable insights and drives policy education and adherence across the organization.

What youll do to make a difference:

• Own the end-to-end medical complaint lifecycle using a dedicated complaint management system.

• Receive document and track complaints from multiple intake channels (e.g. phone email).

• Lead investigations identify root causes and resolve complex or sensitive cases with an elite service mindset and urgency to meet service level agreements.

• Support clinical service recovery activities including customer outreach and refund processing.

• Analyze complaint trends to recommend process product or policy improvements.

• Provide clear confident communication to customers and internal stakeholders throughout resolution.

• Support drafting harmonizing and updating clinical policies across service lines in partnership with clinical leaders.

• Align policy language scope and terminology across MD Live offerings.

• Coordinate structured review and approval processes with Clinical Leadership Legal/Compliance and the Policy Committee.

• Partner with operations nursing and medical directors to implement policy changes and monitor adherence.

• Maintain integrity of complaint and clinical policy data within C360 and other systems.

• Develop KPI dashboards root-cause analyses and leadership-ready reporting.

• Oversee compliance testing and evaluate effectiveness of corrective actions.

• Rebuild and maintain the clinical policy education pathway.

• Deliver hands-on training and communications related to policy updates and regulatory changes.

• Participate in special projects and perform other duties as assigned.

What youll need to succeed:

• Bachelors degree required.

• Project management or process improvement experience required.

• 2 years of experience developing or supporting clinical policy in an ambulatory or inpatient setting.

• 5 years of clinical or healthcare experience focused on improving patient satisfaction.

• Experience with C360 preferred.

• Strong analytical investigative and critical-thinking abilities.

• Demonstrated service recovery conflict resolution and de-escalation skills.

• Ability to manage multiple priorities in a fast-paced dynamic environment.

• Experience with SAIGlobal (C360) Tableau Microsoft Office (Word Excel PowerPoint) and commercial EMR systems.

• Professional adaptable and collaborative approach to achieving clinical operational and strategic objectives.