Medicare Member Services Representative

Peak Health

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

Posted 9/24/2026full-timeRemote • United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates proficiency in handling Medicare claims and providing exceptional customer service while maintaining accuracy and attention to detail. Capable of navigating multiple systems and effectively communicating with members and providers to resolve inquiries.

Highest-signal resume keywords

Medicare Claims ProcessingCustomer Service SkillsAttention To DetailCommunication SkillsProblem-Solving Abilities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare ClaimsMedical Insurance ServicesAdministrative ProceduresClerical ProceduresData EntryTime ManagementMulti-TaskingIssue ResolutionInformation VerificationQuality Standards

Soft Skills

Interpersonal SkillsTelephone EtiquetteSelf-MotivationFocusOrganization

Tools & Technologies

Microsoft Office Professional SuiteInternet ExplorerEPICTelephoneComputerCopierFax Equipment

Certifications & Qualifications

High School DiplomaAssociate Degree (Preferred)

Industry Keywords

Medicare AdvantageD-SNPCMS GuidelinesCare CoordinationEligibility RequirementsMedicare/Medicaid IntegrationMember OutreachClaims ProcessingCustomer ExperienceHealthcare Field

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
Research and resolve member issues and questions with management and peers
Make outbound calls to members and providers for issue resolution or to gather information
Verify member information and address general questions
Resolve inquiries to provide an efficient and seamless member experience
Conduct member outreach as required
Handle Medicare claims processing and related inquiries
Meet production and quality standards and maintain work queues
Communicate effectively with internal and external staff
Escalate issues to the appropriate level of supervision
Ensure accuracy of information gathered and shared on members’ behalf
Attend required training and demonstrate proficiency
Maintain accurate documents, including timekeeping records
Work an 8-hour shift between 7:30 a.m. and 8:00 p.m., Monday through Friday
Work in a standard office environment using telephone, computer, copier, and fax equipment
Travel requirement of 0%–25%

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 navigate 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
Ability to work remotely, including reliability, self-motivation, focus, and time management skills
Associate Degree or greater in a related healthcare field (preferred)
Preferred: three-plus years in a fast-paced call environment with processing and/or customer service experience
Preferred: two years’ experience in Medicare benefits
Preferred: two years’ experience with CMS guidelines
Preferred experience supporting Dual Eligible Special Needs Plans (D-SNP), including Medicaid benefits, care coordination, eligibility requirements, and Medicare/Medicaid service integration
Preferred experience assisting members with D-SNP eligibility determinations, enrollment, benefit inquiries, and Medicare/Medicaid resources
Working knowledge of administrative and clerical procedures and systems
Proficiency with Microsoft Office Professional Suite, Internet Explorer, and EPIC