Medicare Member Engagement Representative

Apex Systems; Akron, Northern (OH, KY); On-site; USD 38,000 - 54,000; Full time

Job summary

Apex Systems is seeking a Medicare Member Engagement Representative to serve as the primary contact for beneficiaries, guiding health plan choices and enrollment changes while ensuring compliant service.

In this on-site Ohio role, you will educate members on plan options, document interactions in CRM, process enrollments, and collaborate with internal teams to resolve concerns and support retention.

Qualifications

• High School Diploma or GED required.
• Associate's degree or Bachelor's degree preferred.
• Minimum of two (2) years of experience in a call center, customer service, or support role within the health insurance industry.
• Experience working directly with Medicare beneficiaries is required.
• Strong understanding of Medicare regulations, health insurance compliance, and Medicare plan benefits.
• Previous healthcare or health insurance industry experience strongly preferred.

Responsibilities

• Assist Medicare beneficiaries with health plan selections, enrollment changes, and benefit-related inquiries using approved guidelines.
• Provide personalized support regarding plan benefits, provider networks, pharmacy coverage, and enrollment options.
• Conduct inbound and outbound member outreach to communicate plan updates, coverage changes, and enrollment opportunities.
• Support member retention initiatives through proactive follow-up and engagement activities.
• Educate members and prospective enrollees on Medicare plan options and benefits.
• Document member interactions in CRM and member management systems.
• Process enrollment transactions and plan changes per established procedures.
• Track enrollment activities to ensure timely completion and accuracy.
• Maintain CMS regulations and company policies compliance.
• Assist with reporting, admin tasks, and database maintenance.
• Collaborate with internal departments to resolve member concerns and deliver positive experience.

Skills

CMS regulations

Customer service

Phone skills

Listening

Problem-solving

Multitasking

CRM platforms

Enrollment systems

MS Office

Team collaboration

Education

High School Diploma or GED

Associate's degree preferred

Bachelor's degree preferred

Tools

CRM systems

Enrollment platforms

MS Office

Job description

Position Overview

The Medicare Member Engagement Representative serves as a primary point of contact for Medicare beneficiaries, providing guidance on health plan options, enrollment changes, benefits, and coverage-related inquiries. This role is responsible for delivering exceptional customer service, supporting member retention efforts, educating members on available healthcare options, and ensuring compliance with Medicare regulations and organizational policies.

Key Responsibilities

• Assist Medicare beneficiaries with health plan selections, enrollment changes, and benefit-related inquiries using approved compliance guidelines.
• Provide personalized support regarding plan benefits, provider networks, pharmacy coverage, and enrollment options.
• Conduct inbound and outbound member outreach to communicate plan updates, coverage changes, and enrollment opportunities.
• Support member retention initiatives through proactive follow-up and engagement activities.
• Educate members and prospective enrollees on Medicare plan options and available benefits.
• Accurately document member interactions within CRM and member management systems.
• Process enrollment transactions and plan change requests in accordance with established procedures.
• Track and monitor enrollment activities to ensure timely completion and accuracy.
• Maintain compliance with CMS regulations, Medicare guidelines, and company policies.
• Assist with reporting, administrative tasks, and database maintenance.
• Collaborate with internal departments to resolve member concerns and deliver a positive customer experience.

Required Qualifications

• High School Diploma or GED required.
• Associate's degree or Bachelor's degree preferred.
• Minimum of two (2) years of experience in a call center, customer service, or support role within the health insurance industry.
• Experience working directly with Medicare beneficiaries is required.
• Strong understanding of Medicare regulations, health insurance compliance, and Medicare plan benefits.
• Previous healthcare or health insurance industry experience strongly preferred.

Preferred Qualifications

• Active Health Insurance License preferred but not required.
• Candidates with an active Health Insurance License may qualify for higher compensation.

Skills & Competencies

• Working knowledge of CMS regulations and Medicare Advantage programs.
• Excellent customer service, communication, and phone skills.
• Strong listening, problem-solving, and critical-thinking abilities.
• Ability to manage multiple tasks and systems simultaneously in a fast-paced environment.
• Strong organizational skills and attention to detail.
• Ability to work independently and collaboratively within a team setting.
• Experience utilizing CRM platforms, enrollment systems, and Microsoft Office applications.
• Ability to build trust and rapport with Medicare members while maintaining professionalism and compliance.
• Strong time‑management skills and ability to prioritize competing responsibilities.

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [e-mail] or 844-463-6178.

Everforth Apex

Everforth Apex is a world‑class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Everforth Apex Benefits Overview

• Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection.
• We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure.
• Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts.
• In terms of professional development, Everforth Apex hosts an on‑demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA.
• Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach.
• You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Everforth Apex team member can provide.

EEO Statement (Duplicate)

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

Disability Accommodation

If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [e-mail] or 804-523-8228. Please note that this contact information is strictly to be used for medical ADA accommodations and that no other inquiries will be answered.

Other Information

UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Everforth Apex Systems.