Medicare Member Services Representative

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. High School diploma or equivalent

EXPERIENCE:

1. One (1) year of experience with handling Medicare claims or related experience

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associate Degree, or greater, in related healthcare field.

EXPERIENCE:

1. Three plus years' experience in a fast-paced call environment with processing and/or customer service experience.

2. Two years' experience in Medicare benefits

3. Two years' experience in knowledge of CMS guidelines

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Verify member information while addressing general questions.

2. Responds to and resolves all issues/inquires to assure an efficient and seamless member experience.

3. Maintains open channels of member communications doing outreach as required.

4. Understanding of Medicare claims processing, and related inquiries.

5. Meets all production and quality standards, maintaining work queues according to department standards.

6. Effectively communicates with internal and external staff.

7. Elevates issues to next level of supervision, as appropriate.

8. Ensures accuracy of information gathered and shared on a member's behalf.

9. Attends all required training classes, demonstrating proficiency and ability to learn.

10. Other duties as deemed appropriate by the Management Team.

11. Maintain accurate documents, including timekeeping records

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to sit for extended periods of time.

2. Ability to answer phone calls for extended periods of time.

3. Lifting 10-25 lbs.

4. Travel Requirement: 0%-25%

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)

2. Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPIC

SKILLS AND ABILITIES:

1. Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.

2. Ability to take direction and to navigate through multiple systems simultaneously.

3. Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.

4. Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.

5. Familiarity with Medical insurance services process.

6. Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

7. Ability to work remotely - this includes reliability, self-motivation, focus & time management skills.

Additional Job Description:

Scheduled Weekly Hours:

Shift:

Exempt/Non-Exempt:

Company:

Cost Center: