Supervisor, Medicare Member Services

🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟠 Senior

🔴 Lead

👻 Ghost score 10%

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

• Supervise and coordinate daily operations and performance of a Medicare Member Services call center team • Monitor call volumes, service levels, average speed of answer, abandonment rates, schedule adherence, quality, productivity, and other performance measures • Ensure accurate member assistance regarding Medicare Advantage and D-SNP benefits, eligibility, enrollment, claims, authorizations, provider access, pharmacy coverage, grievances, and appeals • Ensure compliance with CMS, Medicare, Medicaid, HIPAA, organizational, state, and federal requirements • Monitor calls, CRM records, and member documentation for accuracy, completeness, professionalism, and compliance • Identify training and continuing education needs; conduct coaching, counseling, recognition, corrective action, evaluations, reviews, and one-on-ones • Communicate benefit, policy, regulatory, system, and operational changes through meetings, huddles, training, and email • Oversee SharePoint and other systems for team resources and departmental documentation • Coordinate resolution of member issues with Enrollment, Claims, Pharmacy, Provider Relations, Care Management, Appeals and Grievances, Compliance, Quality, and IT • Handle escalated member, provider, authorized representative, and staff concerns and facilitate compliant resolutions • Identify and refer complaints, grievances, appeals, coverage concerns, and compliance issues within required timeframes • Work with the Manager or Director on departmental goals, performance standards, quality initiatives, and strategic priorities • Maintain confidentiality of personally identifiable information and protected health information • Review reports, quality findings, call-monitoring results, feedback, complaints, and compliance concerns to implement corrective or preventive actions • Support onboarding, system access, training, mentoring, recruitment, interviewing, selection, and retention • Manage schedules, attendance, timekeeping, PTO requests, break/lunch adherence, and staffing coverage • Promote a professional, collaborative, inclusive, accountable, and member-focused work environment • Work Saturday through Wednesday, 12:00 p.m. to 8:00 p.m.; schedule may change based on operational needs

🎯 Requirements

• High school diploma or equivalent and 3 years of experience in a customer service call center environment and 4 years of experience in Medicare, Medicare Advantage, CMS, Medicaid, D-SNP, healthcare compliance, health plan operations, member services, or a related environment; OR associate’s degree and 2 years of experience in a customer service call center environment and 3 years of experience in those Medicare/healthcare-related environments • Strong knowledge of Medicare Advantage, D-SNP, Medicaid, CMS requirements, and health plan operations • Demonstrated ability to lead, coach, motivate, and develop employees in a fast-paced customer service environment • Ability to monitor and interpret call center performance metrics, quality results, productivity measures, and service-level data • Strong decision-making, problem-solving, critical-thinking, and analytical skills • Excellent verbal and written communication skills, including communicating complex healthcare, Medicare, and regulatory information • Ability to sit, stand, walk, and use standard office equipment for extended periods • Preferred: Bachelor’s degree in healthcare administration, business administration, management, communications, or a related field • Preferred: Specialized courses, training, or seminars related 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 supervising employees in a regulated healthcare, health insurance, Medicare, Medicaid, or managed care environment

🏖️ Benefits

• Full-time employment • 40 scheduled weekly hours