Medicare Member Services Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Receive inbound calls from members and providers of Peak Health Medicare Advantage.

• Address inquiries that range from general information to more complex matters.

• Investigate and resolve member queries in collaboration with management and colleagues.

• Place outbound calls to members and providers for issue resolution or information gathering.

• Confirm member details and respond to general inquiries.

• Handle inquiries to ensure a smooth and efficient member experience.

• Conduct outreach to members as necessary.

• Manage Medicare claims processing and related questions.

• Achieve production and quality benchmarks while maintaining work queues.

• Effectively communicate with both internal and external personnel.

• Elevate issues to the appropriate supervisory level when needed.

• Ensure the accuracy of information collected and communicated on behalf of members.

• Participate in mandatory training and demonstrate competency.

• Keep precise records, including timekeeping documentation.

• Work an 8-hour shift scheduled between 7:30 a.m. and 8:00 p.m., Monday through Friday.

• Operate in a standard office setting utilizing telephone, computer, copier, and fax equipment.

• Travel requirement of 0%–25%.

⛳️ Requirements

• High School diploma or equivalent qualification.

• A minimum of one (1) year of experience in handling Medicare claims or relevant experience.

• Capability to sit for prolonged periods.

• Ability to answer phone calls for extended durations.

• Capacity to lift weights ranging from 10 to 25 lbs.

• Proficient in navigating multiple systems simultaneously.

• Exceptional written and verbal communication, customer service, interpersonal skills, and telephone etiquette.

• Skilled in solving problems using established methods and guidelines.

• Familiarity with the medical insurance services process.

• Outstanding attention to detail, organizational skills, and ability to manage multiple tasks at once.

• Ability to work remotely, demonstrating reliability, self-motivation, focus, and effective time management skills.

• An Associate Degree or higher in a relevant healthcare field is preferred.

• Preferred: Over three years of experience in a fast-paced call environment with processing and/or customer service involvement.

• Preferred: Two years of experience in Medicare benefits.

• Preferred: Two years of experience with CMS guidelines.

• Preferred experience in supporting Dual Eligible Special Needs Plans (D-SNP), including knowledge of Medicaid benefits, care coordination, eligibility requirements, and Medicare/Medicaid service integration.

• Preferred experience in assisting members with D-SNP eligibility determinations, enrollment, benefit inquiries, and Medicare/Medicaid resources.

• Working knowledge of administrative and clerical procedures and systems.

• Proficiency with Microsoft Office Professional Suite, Internet Explorer, and EPIC.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching.

• Opportunities for professional development and career advancement.

• Flexible work arrangements and a supportive work environment.