Medicare Member Services Representative - Peak Health

1. High School diploma or equivalent

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

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

1. Three (3) plus years’ experience in a fast-paced call environment with processing and/or customer service experience.

2. Two (2) years’ experience in Medicare benefits

3. Two (2) years’ experience in knowledge of CMS guidelines

4. Experience supporting Dual Eligible Special Needs Plans (D-SNP), including working knowledge of Medicaid benefits, care coordination, eligibility requirements, and the integration of Medicare and Medicaid services to support complex member needs.

5. Experience assisting members with D-SNP eligibility determinations, enrollment processes, benefit-related inquiries, and navigation of Medicare and Medicaid resources to ensure an exceptional member experience.

1. Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.

2. Ability to take direction and to navigate through multiple systems simultaneously.

3. Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.

4. Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.

5. Familiarity with Medical insurance services process.

6. Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.

7. Ability to work remotely – this includes reliability, self-motivation, focus & time management skills.