Medicare Member Services Representative

🔥 2 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 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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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 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 further information • Verify member information while addressing general questions • Resolve issues and inquiries to ensure an efficient and seamless member experience • Maintain member communications and perform 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 classes and demonstrate proficiency • Maintain accurate documents, including timekeeping records

🎯 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. • Travel requirement: 0%-25% • Proficiency with Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC • Working knowledge of administrative and clerical procedures and systems, including word processing and managing files and records • Ability to navigate multiple systems simultaneously • Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette • Ability to solve problems using predefined methods and guidelines • Familiarity with medical insurance services processes • Exceptional attention to detail, organization, multitasking, reliability, self-motivation, focus, and time-management skills • Ability to work remotely