Medicare Member Services Representative - Peak Health
Core
Handle inbound and outbound calls for Peak Health Medicare Advantage members to resolve inquiries, verify information, and navigate Medicare/Medicaid benefits.
Role type
Member Services Representative (Medicare)
Builds
Member support and issue resolution for Peak Advantage Medicare plan
Domain
Healthcare / Medicare Administration
Deliverable
client delivery
Required skills
Medicare claims processing, CMS guidelines knowledge, D-SNP eligibility determinations, enrollment processes, benefit-related inquiries, Medicaid integration
Preferred skills
Dual Eligible Special Needs Plans (D-SNP) support, care coordination, complex member needs navigation
Technologies
Microsoft Office Professional Suite, EPIC
Responsibilities
Verify member information, resolve issues/inquiries, maintain open communication channels, understand Medicare claims processing, meet production/quality standards, communicate with internal/external staff, elevate issues to supervision, ensure information accuracy, attend training, maintain documents
Seniority
Entry-level, individual contributor