Medicare Member Services Representative

WVU Medicine

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

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

Core Competencies

Role fit

Core Competencies

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Demonstrates proficiency in handling Medicare claims processing and related inquiries while ensuring effective communication and exceptional customer service. Capable of maintaining accurate documentation and navigating multiple systems to resolve member issues efficiently.

Highest-signal resume keywords

Medicare Claims ProcessingMicrosoft Office Professional SuiteCustomer ServiceAttention to DetailProblem Solving

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medicare Claims ProcessingAdministrative ProceduresClerical ProceduresDocument ManagementData Entry

Soft Skills

Communication SkillsInterpersonal SkillsTime ManagementMultitaskingSelf-Motivation

Tools & Technologies

Microsoft OutlookMicrosoft WordMicrosoft ExcelMicrosoft AccessEPIC

Industry Keywords

Medicare AdvantageMember ExperienceClaims InquiriesMedical Insurance ServicesQuality Standards

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 further information
Verify member information while addressing general questions
Resolve issues and inquiries to ensure an efficient and seamless member experience
Maintain member communications and perform 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 classes 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.
Travel requirement: 0%-25%
Proficiency with Microsoft Office Professional Suite (Outlook, Word, Excel, Access), Internet Explorer, and EPIC
Working knowledge of administrative and clerical procedures and systems, including word processing and managing files and records
Ability to navigate multiple systems simultaneously
Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette
Ability to solve problems using predefined methods and guidelines
Familiarity with medical insurance services processes
Exceptional attention to detail, organization, multitasking, reliability, self-motivation, focus, and time-management skills
Ability to work remotely