Medicare Member Services Representative

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

📋 Description

• Handle incoming calls from Peak Health Medicare Advantage members and healthcare providers.

• Provide answers to inquiries ranging from basic information to more complex issues.

• Investigate and resolve member concerns and questions in collaboration with management and colleagues.

• Make proactive outbound calls to members and providers for issue resolution or to obtain additional information.

• Confirm member details while addressing general inquiries.

• Address issues and questions to ensure a smooth and efficient experience for members.

• Manage member communications and conduct outreach as necessary.

• Process Medicare claims and handle related inquiries.

• Achieve production and quality benchmarks while managing work queues.

• Effectively communicate with both internal and external staff members.

• Escalate issues to the appropriate supervisory level when required.

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

• Participate in mandatory training sessions and demonstrate competency.

• Keep accurate records, including timekeeping documentation.

⛳️ Requirements

• High School diploma or equivalent qualification.

• Minimum of one (1) year experience in handling Medicare claims or similar roles.

• Capability to sit for prolonged durations.

• Ability to answer phone calls for extended periods.

• Capacity to lift 10-25 lbs.

• Travel requirement: 0%-25%.

• Proficient in Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC.

• Working knowledge of administrative and clerical procedures, including word processing and file management.

• Ability to operate multiple systems concurrently.

• Strong written and verbal communication skills, along with excellent customer service and interpersonal abilities.

• Problem-solving skills using established methods and guidelines.

• Familiarity with processes related to medical insurance services.

• Exceptional attention to detail, organizational skills, multitasking abilities, reliability, self-motivation, focus, and time management skills.

• Capability to work remotely.

🏝️ Benefits

• Comprehensive health benefits.

• Retirement plan options.

• Paid time off and holidays.

• Opportunities for professional development.