Remote Medicare Member Services Advocate

Peak Health; Core (WV); A distancia; USD 21.000 - 30.000; Jornada completa

Descripción de la vacante

Peak Health in West Virginia is seeking a Member Services Representative to handle inbound calls from Medicare Advantage members and providers, and to make outbound calls for resolution and information gathering. The role requires navigating CMS guidelines and supporting D-SNP benefits to ensure a high-quality member experience.

The position expects an 8-hour shift, 7:30 am–8:00 pm, Monday–Friday, with remote work capability and a focus on accurate information, timely responses, and strong

Formación

• High School diploma or equivalent required.
• Associate degree or higher in related healthcare preferred.
• 1 year Medicare claims handling or related experience required.
• 3+ years in a fast-paced call environment with processing or customer service experience preferred.
• 2 years’ experience in Medicare benefits and CMS guidelines preferred.
• Experience supporting D-SNP and navigation of Medicare/Medicaid resources preferred.

Responsabilidades

• Verify member information while addressing general questions.
• Respond to and resolve issues to ensure a seamless member experience.
• Maintain open channels of member communications with outreach as required.
• Understand Medicare claims processing and related inquiries.
• Meet production and quality standards and manage work queues.
• Communicate effectively with internal and external staff.
• Elevate issues to supervisor as appropriate.
• Ensure accuracy of information shared on a member's behalf.
• Attend required training and demonstrate proficiency.
• Maintain accurate documents including timekeeping records.

Conocimientos

Medicare knowledge

Customer service

Call center experience

CMS guidelines

D-SNP experience

Communication skills

Educación

High School diploma or equivalent

Associate degree or higher in related healthcare

Herramientas

EPIC

Microsoft Office

Descripción del empleo

Peak Health in West Virginia is seeking a Member Services Representative to handle inbound calls from Medicare Advantage members and providers, and to make outbound calls for resolution and information gathering. The role requires navigating CMS guidelines and supporting D-SNP benefits to ensure a high-quality member experience.

The position expects an 8-hour shift, 7:30 am–8:00 pm, Monday–Friday, with remote work capability and a focus on accurate information, timely responses, and strong