Medicare Member Services Representative

🔥 17 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• Take inbound calls from Peak Health Medicare Advantage members and providers • Answer questions ranging from general information to complex issues • Work with management and peers to research and resolve member issues and questions • Make outbound calls to members and providers for issue resolution or to gather additional information • Verify member information while addressing general questions • Resolve inquiries and issues to provide an efficient member experience • Conduct member outreach as required • Handle Medicare claims processing and related inquiries • Meet production and quality standards and maintain work queues • Communicate with internal and external staff • Escalate issues to the appropriate supervisory level • Ensure accuracy of information gathered and shared on a member’s behalf • Attend required training and demonstrate proficiency • Maintain accurate documents, including timekeeping records • Perform other duties assigned by management

🎯 Requirements

• High School diploma or equivalent • One (1) year of experience with handling Medicare claims or related experience • Ability to sit for extended periods of time • Ability to answer phone calls for extended periods of time • Ability to lift 10-25 lbs. • Ability to navigate through multiple systems simultaneously • Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette • Ability to solve problems with predefined methods and guidelines • Familiarity with medical insurance services process • Exceptional attention to detail, organization, and ability to perform multiple tasks simultaneously • Ability to work remotely, including reliability, self-motivation, focus, and time management skills • Must be able to work an 8-hour shift between 7:30 am and 8:00 pm, Monday-Friday • Travel requirement: 0%-25% • Preferred: Associate Degree or greater in related healthcare field • Preferred: Three-plus years’ experience in a fast-paced call environment with processing and/or customer service experience • Preferred: Two years’ experience in Medicare benefits • Preferred: Two years’ experience with CMS guidelines • Preferred: Experience supporting D-SNPs, including Medicaid benefits, care coordination, eligibility requirements, and Medicare/Medicaid service integration • Preferred: Experience assisting with D-SNP eligibility determinations, enrollment processes, benefit inquiries, and Medicare/Medicaid resources • Proficiency with Microsoft Office Professional Suite, Internet Explorer, and EPIC