Temporary - Member Service Specialist

Trinity Health; Columbus (OH); Remote; USD 22,000 - 30,000; Full time

Benefits offered by this job

Medical benefits from day one

Retirement with employer match

Tuition reimbursement

DailyPay access

Relocation assistance

Job summary

Trinity Health's Mount Carmel Health System seeks a vigilant Member Service Representative to handle Medicare Advantage inquiries by phone, in person, or in writing. The role emphasizes compliant, compassionate service, retention strategies, and high CMS satisfaction scores.

The temporary, seasonal position runs through April 2027 with M-F daytime hours and a remote option, requiring knowledge of Medicare rules and strong customer service skills. Relevant ODI and CMS familiarity is preferred.

Qualifications

• Customer Service experience with government/regulations desired.
• Effective communication and ability to multitask in a fast-paced environment.
• Knowledge of CMS regulations and Medicare processes is helpful.

Responsibilities

• Respond to consumer inquiries via phone, in person, or written.
• Ensure compliance with CMS/ODI/NCQA and other regulations.
• Meet/exceed service level goals for CMS ratings.
• Assist with gaps in care and coordinate with interpreters for LEP customers.
• Articulate outcomes to achieve desired results.

Skills

Customer Service

CMS rules

Medicare knowledge

Effective communication

Multitasking

Call center experience

Education

High school diploma, some college preferred

Tools

CMS/Regulations

Job description

Employment Type: Full time Shift: Day Shift Description: *REMOTE OPPORTUNITY*

This position is temporary/seasonal through April 2027. The schedule is M-F, 8am-4:30pm or 8:30-5pm EST. Medicare Advantage experience would be helpful, managed care, health insurance, as well as customer service and call center experience.

Position Purpose:

In accordance with the Mission and Guiding Behaviors; the Member Service Representative responds to all consumer inquiries received by phone, in person or in writing regarding product plan benefits, services, organizational determinations, reconsiderations, complaints and general inquiries in accordance with the rules and regulations of a Medicare Advantage plan and governing agencies. Implements retention strategies to maintain current membership and improve the quality of care and service.

What You Will Do:

Complies with internal policies, Center for Medicare and Medicaid Services (CMS), Ohio Department of Insurance (ODI), NCQA and all applicable Federal regulations. Develop a thorough understanding of the applicable rules and audit protocols that govern all aspects consumer service activities and demonstrated ability to pass audits of activities. Engages with consumers to effectively meet or exceed individual and team service performance goals in a manner that is compliant with all Federal, State and governing requirements. Meets or exceeds Federal service level requirements for a Medicare Managed Care call center monitored by CMS or their appointed representatives. Receive, interpret and accurately respond to consumer inquiries, both verbally and in writing in ways that reflect a positive, compassionate and affirming manner while ensuring compliance with Federal regulations. Outreach to members and providers to close gaps in care, create and maintain relationships and obtain accurate information. Must be able to articulate and achieve desired outcomes. To discern the needs of consumers with commitment to providing the highest level of service possible with measurable outcomes. Utilize interpreting services and accurately provide answers to consumers via foreign language interpreters to assist limited English speaking consumers. Achieve and maintain a superior (5-STAR) CMS rating in member/consumer satisfaction.

Minimum Qualifications:

Education: Minimum of high school education with some college level studies preferred.

Experience: Customer Service along with knowledge of governmental agencies and regulations, especially Medicare and the Centers for Medicare and Medicaid Services (CMS) desired. Effective Communication Skills; consumer retention and strategic thinking. Demonstrated knowledge and effective organizing multi-tasks, in a high volume, fast-paced team environment.

Position Highlights and Benefits:

• Mount Carmel Health System recognized by Forbes in 2025 as one of America's Best State Employers.
• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel's College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• Mount Carmel offers DailyPay - if you're hired as an eligible colleague, you'll be able to see how much you've made every day and transfer your money any time before payday.
• You deserve to get paid every day!
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry/Facility Information:

Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you're seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You! Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care.

We are an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation.

Together, we're 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.