Remote Medicare Member Services Specialist

Peak Health; Core (WV); Remote; USD 32,000 - 42,000; Full time

Job summary

PHH Peak Health Holdings is seeking a Member Services Representative to support Peak Health Medicare Advantage members and providers. You will handle inbound calls, research and resolve questions, and perform outbound follow-ups to gather information, ensuring a smooth member experience in a call-center environment.

The role requires attention to detail, strong communication, and familiarity with Medicare processes.

Qualifications

• High School diploma or equivalent.
• 1 year of Medicare claims handling experience.
• Associate degree or greater preferred.
• 3+ years in a fast-paced call environment with processing or customer service experience.
• 2 years’ experience in Medicare benefits and CMS guidelines.
• DSNP experience and Medicare/Medicaid navigation knowledge preferred.

Responsibilities

• Verify member information and address general questions.
• Respond to and resolve issues to ensure efficient member experience.
• Maintain open member communication and perform outreach as required.
• Understand Medicare claims processing and related inquiries.
• Meet production and quality standards and manage work queues.
• Communicate effectively with internal/external staff and escalate when needed.
• Attend required training and maintain accurate documentation.

Skills

Medicare knowledge

Customer service

Phone support

Remote work capability

Education

High School diploma

Associate degree (preferred)

Tools

EPIC

Microsoft Office

Job description

PHH Peak Health Holdings is seeking a Member Services Representative to support Peak Health Medicare Advantage members and providers. You will handle inbound calls, research and resolve questions, and perform outbound follow-ups to gather information, ensuring a smooth member experience in a call-center environment.

The role requires attention to detail, strong communication, and familiarity with Medicare processes.