Medicare Member Services Team Lead

WVU Medicine; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

PHH Peak Health Holdings is seeking a Supervisor of Medicare Advantage Call Center to lead a team delivering compliant, high-quality member services in a Medicare-focused operation. The role emphasizes coaching, performance oversight, and cross-department collaboration to resolve issues and improve processes in a fast-paced environment.

The position requires experience in healthcare call centers, CMS regulations, and HIPAA, with a schedule that includes weekends.

Qualifications

• Strong knowledge of Medicare Advantage, D-SNP, Medicaid and CMS requirements.
• Experience leading a regulated healthcare call center.
• Ability to monitor call center metrics and ensure service levels.
• Experience coaching staff and conducting performance reviews.
• Familiarity with HIPAA and healthcare compliance standards.

Responsibilities

• Supervises daily Medicare Member Services representatives to ensure accurate, timely and member-focused service.
• Monitors call volumes, service levels, average speed of answer, and quality results.
• Ensures accurate information on Medicare Advantage and D-SNP benefits, eligibility, enrollment, claims and provider access.
• Maintains compliance with CMS, Medicaid, HIPAA and internal policies.
• Documents member interactions accurately and ensures proper CRM records.
• Identifies training needs and conducts ongoing staff development.
• Performs annual and 90-day performance evaluations and regular one-on-one meetings.
• Supports onboarding, system access, and transition to independent call handling.

Skills

Medicare knowledge

Leadership

Call center operations

Compliance

Training and coaching

Performance monitoring

Education

Bachelor’s degree in healthcare administration / related field

Specialized courses related to Medicare / CMS

Tools

SharePoint

CRM systems

Job description

PHH Peak Health Holdings is seeking a Supervisor of Medicare Advantage Call Center to lead a team delivering compliant, high-quality member services in a Medicare-focused operation. The role emphasizes coaching, performance oversight, and cross-department collaboration to resolve issues and improve processes in a fast-paced environment.

The position requires experience in healthcare call centers, CMS regulations, and HIPAA, with a schedule that includes weekends.