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Supervisor, Medicare Member Services
Peak Health. Supervise and coordinate daily operations and performance of a Medicare Member Services call center team .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong leadership and coaching abilities in a Medicare Member Services call center environment, ensuring compliance with CMS, Medicare, and Medicaid regulations while effectively managing team performance metrics and member services.
Highest-signal resume keywords
Medicare Advantage KnowledgeD-SNP ExperienceCall Center Performance MonitoringLeadership and Coaching SkillsHealthcare Compliance Expertise
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Customer Service ManagementPerformance Metrics AnalysisRegulatory ComplianceQuality AssuranceTraining and Development
Soft Skills
Decision-MakingProblem-SolvingCritical ThinkingVerbal CommunicationWritten Communication
Tools & Technologies
CRM SystemsSharePoint
Industry Keywords
CMS RequirementsMedicaidHealth Plan OperationsManaged CareHealthcare Compliance
About the role
Key responsibilities & impact- Supervise and coordinate daily operations and performance of a Medicare Member Services call center team
- Monitor call volumes, service levels, average speed of answer, abandonment rates, schedule adherence, quality, productivity, and other performance measures
- Ensure accurate member assistance regarding Medicare Advantage and D-SNP benefits, eligibility, enrollment, claims, authorizations, provider access, pharmacy coverage, grievances, and appeals
- Ensure compliance with CMS, Medicare, Medicaid, HIPAA, organizational, state, and federal requirements
- Monitor calls, CRM records, and member documentation for accuracy, completeness, professionalism, and compliance
- Identify training and continuing education needs; conduct coaching, counseling, recognition, corrective action, evaluations, reviews, and one-on-ones
- Communicate benefit, policy, regulatory, system, and operational changes through meetings, huddles, training, and email
- Oversee SharePoint and other systems for team resources and departmental documentation
- Coordinate resolution of member issues with Enrollment, Claims, Pharmacy, Provider Relations, Care Management, Appeals and Grievances, Compliance, Quality, and IT
- Handle escalated member, provider, authorized representative, and staff concerns and facilitate compliant resolutions
- Identify and refer complaints, grievances, appeals, coverage concerns, and compliance issues within required timeframes
- Work with the Manager or Director on departmental goals, performance standards, quality initiatives, and strategic priorities
- Maintain confidentiality of personally identifiable information and protected health information
- Review reports, quality findings, call-monitoring results, feedback, complaints, and compliance concerns to implement corrective or preventive actions
- Support onboarding, system access, training, mentoring, recruitment, interviewing, selection, and retention
- Manage schedules, attendance, timekeeping, PTO requests, break/lunch adherence, and staffing coverage
- Promote a professional, collaborative, inclusive, accountable, and member-focused work environment
- Work Saturday through Wednesday, 12:00 p.m. to 8:00 p.m.; schedule may change based on operational needs
Requirements
What you’ll need- High school diploma or equivalent and 3 years of experience in a customer service call center environment and 4 years of experience in Medicare, Medicare Advantage, CMS, Medicaid, D-SNP, healthcare compliance, health plan operations, member services, or a related environment; OR associate’s degree and 2 years of experience in a customer service call center environment and 3 years of experience in those Medicare/healthcare-related environments
- Strong knowledge of Medicare Advantage, D-SNP, Medicaid, CMS requirements, and health plan operations
- Demonstrated ability to lead, coach, motivate, and develop employees in a fast-paced customer service environment
- Ability to monitor and interpret call center performance metrics, quality results, productivity measures, and service-level data
- Strong decision-making, problem-solving, critical-thinking, and analytical skills
- Excellent verbal and written communication skills, including communicating complex healthcare, Medicare, and regulatory information
- Ability to sit, stand, walk, and use standard office equipment for extended periods
- Preferred: Bachelor’s degree in healthcare administration, business administration, management, communications, or a related field
- Preferred: Specialized courses, training, or seminars related to Medicare, CMS regulations, managed care, healthcare compliance, call center operations, leadership, or business management
- Preferred: 2 years of experience in healthcare, health insurance, managed care, or Medicare Advantage
- Preferred: 2 years of experience in a team lead or direct supervisory role overseeing customer service or call center associates
- Preferred: Experience supervising employees in a regulated healthcare, health insurance, Medicare, Medicaid, or managed care environment
Benefits
Comp & perks- Full-time employment
- 40 scheduled weekly hours