Medicare Member Services Representative

About the role

Join the Peak Health team at WVU Medicine as a Member Services Representative, contributing to the foundation for an innovative, Peak Advantage Medicare plan. The Medicare Membership Services Representative will take inbound calls from Peak Health Medicare Advantage members, and providers answering questions ranging from general information to complex inquires on a wide range of issues. This role will work with management and peers on the Peak team to research and resolve member issues and questions. In addition to taking inbound calls, will make outbound calls to members and providers with issue resolution or to gather further information.

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.
• Maintains accuracy of information gathered and shared on a member’s behalf.
• Elevates issues to next level of supervision, as appropriate.
• Maintains accurate documents, including timekeeping records.

Qualifications

• MINIMUM QUALIFICATIONS: High School diploma or equivalent, one (1) year of experience with handling Medicare claims or related experience.
• PREFERRED QUALIFICATIONS: 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.

Physical Requirements

• Ability to sit for extended periods of time.
• Ability to answer phone calls for extended periods of time.
• Lifting 10-25 lbs.

Working Environment

• Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.).
• Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPIC.

Skills and Abilities

• Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.
• Exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
• Ability to work remotely – this includes reliability, self-motivation, focus & time management skills.

Additional Job Description

• Scheduled Weekly Hours: 40
• Exempt/Non-Exempt: Shift: United States of America (Non-Exempt)
• Company: PHH Peak Health Holdings
• Cost Center: 2911 PHH Member Services