Supervisor, Medicare Member Services

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

📋 Description

• Oversee and coordinate the daily operations and performance of a call center team dedicated to Medicare Member Services.

• Track call volumes, service levels, average response times, abandonment rates, schedule adherence, quality, productivity, and various performance metrics.

• Guarantee precise member assistance concerning Medicare Advantage and D-SNP benefits, eligibility, enrollment, claims, authorizations, provider access, pharmacy coverage, grievances, and appeals.

• Ensure adherence to CMS, Medicare, Medicaid, HIPAA, organizational, state, and federal regulations.

• Review calls, CRM records, and member documentation for accuracy, completeness, professionalism, and compliance.

• Recognize training and continuing education needs; conduct coaching, counseling, recognition, corrective actions, evaluations, reviews, and one-on-one meetings.

• Communicate changes in benefits, policies, regulations, systems, and operations through meetings, huddles, training sessions, and emails.

• Manage SharePoint and other systems for team resources and departmental documentation.

• Coordinate the resolution of member issues with Enrollment, Claims, Pharmacy, Provider Relations, Care Management, Appeals and Grievances, Compliance, Quality, and IT.

• Address escalated concerns from members, providers, authorized representatives, and staff, facilitating compliant resolutions.

• Identify and escalate complaints, grievances, appeals, coverage issues, and compliance matters within required timelines.

• Collaborate with the Manager or Director on departmental objectives, performance standards, quality initiatives, and strategic priorities.

• Uphold the confidentiality of personally identifiable information and protected health information.

• Analyze reports, quality findings, call-monitoring results, feedback, complaints, and compliance issues to implement corrective or preventive measures.

• Assist with onboarding, system access, training, mentoring, recruitment, interviewing, selection, and employee retention.

• Oversee schedules, attendance, timekeeping, PTO requests, adherence to breaks/lunch, and staffing coverage.

• Foster a professional, collaborative, inclusive, accountable, and member-oriented work environment.

• Work from Saturday to Wednesday, 12:00 p.m. to 8:00 p.m.; schedule may be adjusted based on operational requirements.

⛳️ Requirements

• High school diploma or equivalent along with 3 years of experience in a customer service call center and 4 years of experience in Medicare, Medicare Advantage, CMS, Medicaid, D-SNP, healthcare compliance, health plan operations, member services, or a relevant field; OR an associate’s degree with 2 years of experience in a customer service call center and 3 years of experience in those Medicare/healthcare-related areas.

• Strong understanding of Medicare Advantage, D-SNP, Medicaid, CMS requirements, and health plan operations.

• Proven ability to lead, coach, motivate, and develop employees in a dynamic customer service setting.

• Capability to monitor and interpret call center performance metrics, quality outcomes, productivity indicators, and service-level data.

• Strong decision-making, problem-solving, critical-thinking, and analytical abilities.

• Excellent verbal and written communication skills, including the ability to convey complex healthcare, Medicare, and regulatory information clearly.

• Ability to sit, stand, walk, and utilize standard office equipment for prolonged periods.

• Preferred: Bachelor’s degree in healthcare administration, business administration, management, communications, or a related discipline.

• Preferred: Specialized courses, training, or seminars relating to Medicare, CMS regulations, managed care, healthcare compliance, call center operations, leadership, or business management.

• Preferred: 2 years of experience in healthcare, health insurance, managed care, or Medicare Advantage.

• Preferred: 2 years of experience in a team lead or direct supervisory role overseeing customer service or call center associates.

• Preferred: Experience in supervising employees within a regulated healthcare, health insurance, Medicare, Medicaid, or managed care context.

🏝️ Benefits

• Full-time employment.

• 40 scheduled weekly hours.