Medicare Retention Specialist

Position Summary

The Medicare Retention Specialist supports member retention efforts by providing exceptional customer service to Medicare Advantage members. This role focuses on addressing member concerns, resolving issues, and educating members on plan benefits to improve satisfaction and reduce voluntary disenrollment. This is an entry-level position ideal for candidates interested in healthcare, insurance, or customer service careers.

Essential Duties And Responsibilities

• Respond to inbound and outbound calls from Medicare members regarding plan questions, concerns, and potential disenrollment requests
• Identify at-risk members and take proactive steps to improve retention
• Educate members on plan benefits, coverage, and available resources
• Resolve member issues related to claims, billing, pharmacy, and provider access
• Document all interactions accurately in the system in compliance with CMS guidelines
• Collaborate with internal departments (claims, enrollment, provider relations) to resolve escalated member issues
• Follow all compliance and regulatory requirements related to Medicare Advantage plans
• Maintain performance metrics such as call quality, productivity, and retention goals

Qualifications And Education

• High school diploma or equivalent required
• 1-2 years of experience in customer service, call center, or healthcare environment required
• Bilingual (English/Spanish) required
• Strong verbal and written communication and problem-solving skills
• Basic computer proficiency (Microsoft Office, Excel, Outlook, CRM systems and ability to learn new systems quickly)
• Ability to handle sensitive situations with empathy and professionalism
• High level of professionalism and ability to handle confidential information

Preferred Qualifications

• Experience working with Medicare or health insurance plans
• Knowledge of CMS regulations (a plus, not required)
• Prior experience in retention efforts

Core Competencies

• Empathy and emotional intelligence
• Customer focus and service excellence
• Problem solving and critical thinking
• Communication skills (verbal and written)
• Team collaboration, works efficiently with internal depts.

Working Conditions

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
• Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
• The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds.
• While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl.
• Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Performance Measurements

• Duties accomplished at the end of the day/month.
• Attendance/punctuality.
• Compliance with Company regulations.
• Safety and Security.
• Quality of work.