Note: The job is a remote job and is open to candidates in USA. Peak Health is seeking a Medicare Member Services Representative to join their team at WVU Medicine. This role involves taking inbound and making outbound calls to assist Medicare Advantage members and providers with inquiries and issue resolution, contributing to a seamless member experience.
Responsibilities
- Verify member information while addressing general questions
- Responds to and resolves all issues/inquires to assure an efficient and seamless member experience
- Maintains open channels of member communications doing outreach as required
- Understanding of Medicare claims processing, and related inquiries
- Meets all production and quality standards, maintaining work queues according to department standards
- Effectively communicates with internal and external staff
- Elevates issues to next level of supervision, as appropriate
- Ensures accuracy of information gathered and shared on a member’s behalf
- Attends all required training classes, demonstrating proficiency and ability to learn
- Other duties as deemed appropriate by the Management Team
- Maintain accurate documents, including timekeeping records
Skills
- High School diploma or equivalent
- One (1) year of experience with handling Medicare claims or related experience
- Associate Degree, or greater, in related healthcare field
- Three (3) plus years' experience in a fast-paced call environment with processing and/or customer service experience
- Two (2) years' experience in Medicare benefits
- Two (2) years' experience in knowledge of CMS guidelines
- Experience supporting Dual Eligible Special Needs Plans (D-SNP), including working knowledge of Medicaid benefits, care coordination, eligibility requirements, and the integration of Medicare and Medicaid services to support complex member needs
- Experience assisting members with D-SNP eligibility determinations, enrollment processes, benefit-related inquiries, and navigation of Medicare and Medicaid resources to ensure an exceptional member experience
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