Medicare Member Services Representative

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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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 • Research and resolve member issues and questions with management and peers • Make outbound calls to members and providers for issue resolution or to gather information • Verify member information and address general questions • Resolve inquiries to provide an efficient and seamless member experience • Conduct member outreach as required • Handle Medicare claims processing and related inquiries • Meet production and quality standards and maintain work queues • Communicate effectively with internal and external staff • Escalate issues to the appropriate level of supervision • Ensure accuracy of information gathered and shared on members’ behalf • Attend required training and demonstrate proficiency • Maintain accurate documents, including timekeeping records • Work an 8-hour shift between 7:30 a.m. and 8:00 p.m., Monday through Friday • Work in a standard office environment using telephone, computer, copier, and fax equipment • Travel requirement of 0%–25%

🎯 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 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 • Associate Degree or greater in a related healthcare field (preferred) • Preferred: three-plus years 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 Dual Eligible Special Needs Plans (D-SNP), including Medicaid benefits, care coordination, eligibility requirements, and Medicare/Medicaid service integration • Preferred experience 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