Medicare Member Services Representative

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Come join our Peak Health team at WVU Medicine as a Member Services Representative, contributing to the foundation for an innovative, Peak Advantage Medicare plan. The Medicare Membership Services Representative will take inbound calls from Peak Health Medicare Advantage members, and providers answering questions ranging from general information to complex inquires on a wide range of issues. This role will work with management and peers on the Peak team to research and resolve member issues and questions.

In addition to taking inbound calls, will make outbound calls to members and providers with issue resolution or to gather further information. Candidates should expect to work an 8-hour shift, between the hours of 7:30 am – 8:00 pm Monday – Friday.

• High School diploma or equivalent

• One (1) year of experience with handling Medicare claims or related experience

• Associate Degree, or greater, in related healthcare field.

• Three plus years’ experience in a fast-paced call environment with processing and/or customer service experience.
• Two years’ experience in Medicare benefits
• Two years’ experience in knowledge of CMS guidelines

• Verify member information while addressing general questions.
• Responds to and resolves all issues/inquires to assure an efficient and seamless member experience.
• Maintains open channels of member communications doing outreach as required.
• Understanding of Medicare claims processing, and related inquiries.
• Meets all production and quality standards, maintaining work queues according to department standards.
• Effectively communicates with internal and external staff.
• Elevates issues to next level of supervision, as appropriate.
• Ensures accuracy of information gathered and shared on a member’s behalf.
• Attends all required training classes, demonstrating proficiency and ability to learn.
• Other duties as deemed appropriate by the Management Team.
• Maintain accurate documents, including timekeeping records

• Ability to sit for extended periods of time.
• Ability to answer phone calls for extended periods of time.
• Lifting 10-25 lbs.
• Travel Requirement: 0%-25%

• Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
• Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPIC

• Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to take direction and to navigate through multiple systems simultaneously.
• Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.
• Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.
• Familiarity with Medical insurance services process.
• Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
• Ability to work remotely – this includes reliability, self-motivation, focus & time management skills.

Scheduled Weekly

Hours:

40

Exempt/Non-Exempt:
United States of America (Non-Exempt)

Shift: United States of America (Non-Exempt)

Company: PHH Peak Health Holdings

Cost Center: 2902 PHH Claims Operations