Medicare Member Service Representative

About the role

Responsible for providing exceptional customer service to Medicare beneficiaries by handling inquiries, resolving concerns, and offering guidance on benefits, claims, billing, and enrollment. This role supports patients and members within a healthcare organization through phone-based, email, and in-person interactions, and plays a key role in ensuring a positive member experience.

Responsibilities

• Respond to inbound calls, emails, and inquiries from Medicare members, family members, and caregivers regarding coverage, eligibility, claims, and billing.
• Aid members in understanding their Medicare plan benefits and how to access services within the healthcare network.
• Document all member interactions accurately in customer service or call center systems.
• Collaborate with departments such as billing, care management, and clinical teams to resolve complex member issues or escalations.
• Educate members on preventive services, appointment scheduling, and care navigation resources.
• Follow scripts, protocols, and compliance guidelines in accordance with Medicare and CMS regulations.
• Maintain confidentiality and protect patient/member information per HIPAA guidelines.
• Identify recurring concerns or patterns and escalate trends to leadership to improve processes.
• Meet performance and quality metrics such as call volume, response time, and customer satisfaction scores.

Qualifications

• Education: High School Diploma or Equivalent required. Associate's Degree Healthcare Administration preferred or Associate's Degree Business preferred or Associate's Degree Related Field of Study preferred.
• Experience: 1-2 years required in Customer Service, preferably in a healthcare, insurance, or call center setting. 0-1 year preferred working with Medicare beneficiaries, healthcare billing, or insurance plans.
• Knowledge, Skills And Abilities: Strong understanding of Medicare benefits, claims processes, and CMS guidelines. Excellent verbal and written communication skills. Ability to remain calm and empathetic when dealing with frustrated or confused members. Strong attention to detail, accuracy, and documentation. Ability to multitask in a high-volume, fast-paced call center environment. Proficient in Microsoft Office and call tracking software.

Additional Job Details

• Mandatory Working Model: Monday - Friday EST Hours. Training Schedule: M-F 8:30 AM – 5:00 PM EST. Post-training Schedule, shift will range between the following: 8:00 AM - 4:30 PM EST, 8:30 AM - 5 PM EST, 9:00 AM - 5:30 PM EST, or 11:30 AM - 8:00 PM EST. This is a remote position; a quiet, secure, stable, and compliant work station is required from within the US, with MGB-provided equipment and Video required during the work week. Start Date required: August 24, 2026. An on-camera video interview is required to be considered for the position. Remote Work Location: 399 Revolution Drive. Pay Range: $22.22 - $31.71/Hourly Grade 4.