Medicare Member Services Representative

Role overview Support members of a Medicare plan and healthcare providers by answering questions, researching concerns, and coordinating resolutions. The representative handles both inbound and outbound calls and may address topics ranging from general plan information to claims and more complex coverage or eligibility issues. The schedule is 40 hours per week, with an eight-hour weekday shift scheduled between 7:30 a.m. and 8:00 p.m.

Responsibilities - Verify member details and respond accurately to questions about plan services and claims. - Research and resolve member or provider inquiries, seeking additional information by phone when needed. - Maintain clear communication with members and internal teams, escalating issues when appropriate. - Keep work queues, documents, and time records accurate while meeting department quality and productivity standards. - Attend required training and demonstrate the ability to use multiple systems and follow established procedures.

Requirements - High school diploma or equivalent. - At least one year of experience handling Medicare claims or related work. - Strong written and verbal communication, customer service, and telephone skills. - Attention to detail and the ability to stay organized while handling multiple tasks and systems. - Working knowledge of administrative procedures, records, and basic office software. - Ability to work independently and reliably in a remote setting, with focus and sound time management.

Nice to have - An associate degree or higher in a healthcare-related field. - Three or more years in a busy call or customer service environment, plus experience with Medicare benefits and CMS guidelines. - Familiarity with dual-eligible plans, including Medicare and Medicaid benefits, eligibility, enrollment, care coordination, and helping members navigate available resources.

Benefits and work setup The position is described as remote-capable, with weekday scheduling. The work involves extended periods sitting and answering calls; occasional lifting of 10–25 pounds and travel of up to 25% are listed.