Medicare Member Engagement Representative

About the role

The Medicare Member Engagement Representative serves as a primary point of contact for Medicare beneficiaries, providing guidance on health plan options, enrollment changes, benefits, and coverage-related inquiries. This role delivers exceptional customer service, supports member retention efforts, educates members on available healthcare options, and ensures compliance with Medicare regulations and organizational policies.

Responsibilities

• Assist Medicare beneficiaries with health plan selections, enrollment changes, and benefit-related inquiries using approved compliance guidelines.
• Provide personalized support regarding plan benefits, provider networks, pharmacy coverage, and enrollment options.
• Conduct inbound and outbound member outreach to communicate plan updates, coverage changes, and enrollment opportunities.
• Support member retention initiatives through proactive follow-up and engagement activities.
• Educate members and prospective enrollees on Medicare plan options and available benefits.
• Accurately document member interactions within CRM and member management systems.
• Process enrollment transactions and plan change requests in accordance with established procedures.
• Track and monitor enrollment activities to ensure timely completion and accuracy.
• Maintain compliance with CMS regulations, Medicare guidelines, and company policies.
• Assist with reporting, administrative tasks, and database maintenance.
• Collaborate with internal departments to resolve member concerns and deliver a positive customer experience.

Required Qualifications

• High School Diploma or GED required.
• Associate’s degree or Bachelor’s degree preferred.
• Minimum of two (2) years of experience in a call center, customer service, or support role within the health insurance industry.
• Experience working directly with Medicare beneficiaries is required.
• Strong understanding of Medicare regulations, health insurance compliance, and Medicare plan benefits.
• Previous healthcare or health insurance industry experience strongly preferred.

Preferred Qualifications

• Active Health Insurance License preferred but not required.
• Candidates with an active Health Insurance License may qualify for higher compensation.

Skills & Competencies

• Working knowledge of CMS regulations and Medicare Advantage programs.
• Excellent customer service, communication, and phone skills.
• Strong listening, problem-solving, and critical-thinking abilities.
• Ability to manage multiple tasks and systems simultaneously in a fast-paced environment.
• Strong organizational skills and attention to detail.
• Ability to work independently and collaboratively within a team setting.
• Experience utilizing CRM platforms, enrollment systems, and Microsoft Office applications.
• Ability to build trust and rapport with Medicare members while maintaining professionalism and compliance.
• Strong time-management skills and ability to prioritize competing responsibilities.

Benefits

• Medical, dental, vision, life, and disability insurance plans with optional supplemental coverage.
• Employee Stock Purchase Program (ESPP) and 401(k) program with company match after 12 months of tenure.
• Health Savings Account (HSA) eligibility on the HDHP plan.
• SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions.
• Corporate discount savings program and other discounts.
• On-demand training program and access to certification prep and a library of technical and leadership courses/books/seminars after 6+ months of tenure.
• Certification discounts and other perks through associations such as CompTIA and IIBA.
• Dedicated customer service team for consultants and access to a certified Career Coach.