New

Medicare Member Service Representative

Mass General Brigham Health Plan
$22.22 - $31.71

399 Revolution Drive (Show on map)
Jul 07, 2026
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. Essential Functions: -Respond to inbound calls, emails, and inquiries from Medicare members, family members, and caregivers regarding coverage, eligibility, claims, and billing. -Assist 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. 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 Experience in Customer Service, preferably in a healthcare, insurance, or call center setting 1-2 years required Experience working with Medicare beneficiaries, healthcare billing, or insurance plans 0-1 year preferred Experience with CRM, call center software, or electronic health records (EHR) systems 0-1 year preferred Bilingual in Spanish, Haitian Creole, and Vietnamese preferred 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. 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 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.