Medicare Member Services Representative

Peak Health

. Take inbound calls from Peak Health Medicare Advantage members and providers .

Posted 11/10/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in handling Medicare claims and providing exceptional customer service while maintaining accurate documentation and communication. Capable of navigating multiple systems and processes to resolve member inquiries efficiently.

Highest-signal resume keywords

Medicare Claims ProcessingCustomer Service SkillsAttention To DetailMicrosoft Office Professional SuiteKnowledge Of CMS Guidelines

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare Claims ProcessingAdministrative ProceduresClerical ProceduresProblem SolvingTime ManagementData EntryRecord ManagementTelephone EtiquetteMedical Insurance ServicesD-SNP Eligibility Determinations

Soft Skills

Excellent CommunicationInterpersonal SkillsSelf-MotivationOrganizationAbility To Multitask

Tools & Technologies

Microsoft Office Professional SuiteInternet ExplorerEPIC

Industry Keywords

Medicare AdvantageDual Eligible Special Needs PlansCare CoordinationEligibility RequirementsMedicaid Benefits

About the role

Key responsibilities & impact

Take inbound calls from Peak Health Medicare Advantage members and providers
Answer questions ranging from general information to complex issues
Work with management and peers to research and resolve member issues and questions
Make outbound calls to members and providers for issue resolution or to gather further information
Verify member information while addressing general questions
Respond to and resolve issues and inquiries to ensure an efficient member experience
Maintain member communications and conduct outreach as required
Address Medicare claims processing and related inquiries
Meet production and quality standards and maintain work queues
Communicate with internal and external staff
Escalate issues to the appropriate supervisory level
Ensure accuracy of information gathered and shared on a member’s behalf
Attend required training and demonstrate proficiency
Maintain accurate documents, including timekeeping records

Requirements

What you’ll need

High School diploma or equivalent
One (1) year of experience with handling Medicare claims or related experience
Ability to sit for extended periods of time
Ability to answer phone calls for extended periods of time
Ability to lift 10-25 lbs.
Ability to work remotely, including reliability, self-motivation, focus, and time management skills
Working knowledge of administrative and clerical procedures and systems such as word processing and managing files and records
Ability to take direction and 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
Familiarity with medical insurance services process
Exceptional attention to detail, organization, and ability to perform multiple tasks simultaneously
Microsoft Office Professional Suite, Internet Explorer, and EPIC
Preferred: Associate Degree or greater in related healthcare field
Preferred: Three (3) plus years’ experience in a fast-paced call environment with processing and/or customer service experience
Preferred: Two (2) years’ experience in Medicare benefits
Preferred: Two (2) years’ experience in knowledge of CMS guidelines
Preferred experience supporting Dual Eligible Special Needs Plans (D-SNP), including Medicaid benefits, care coordination, eligibility requirements, and integration of Medicare and Medicaid services
Preferred experience assisting members with D-SNP eligibility determinations, enrollment processes, benefit-related inquiries, and navigation of Medicare and Medicaid resources