Supervisor, Medicare Member Services

WVU Medicine

. Supervise and coordinate the daily operations and performance of a Medicare Member Services call center team .

Posted 10/2/2026full-timeRemote • United StatesSeniorLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong leadership and operational oversight in managing a Medicare Member Services call center, ensuring compliance with CMS and healthcare regulations while effectively coaching and developing team members. Proficient in monitoring call center performance metrics and implementing quality improvement initiatives to enhance service delivery.

Highest-signal resume keywords

Medicare Advantage ExpertiseD-SNP KnowledgeCMS ComplianceCall Center Performance MonitoringLeadership and Coaching

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Customer Service ManagementHealthcare CompliancePerformance Metrics AnalysisQuality AssuranceOperational Oversight

Soft Skills

Decision-MakingProblem-SolvingCritical ThinkingVerbal CommunicationWritten Communication

Tools & Technologies

CRM SystemsSharePoint

Industry Keywords

MedicareMedicaidDual Eligible Special Needs PlansHealth Plan OperationsRegulatory Compliance

About the role

Key responsibilities & impact

Supervise and coordinate the daily operations and performance of a Medicare Member Services call center team
Provide leadership, coaching, counseling, recognition, corrective action, and operational oversight
Monitor call volumes, service levels, average speed of answer, abandonment rates, schedule adherence, quality, productivity, and other performance measures
Ensure accurate information is provided regarding Medicare Advantage and D-SNP benefits, eligibility, enrollment, claims, authorizations, provider access, pharmacy coverage, grievances, and appeals
Ensure compliance with CMS requirements, Medicare and Medicaid regulations, D-SNP requirements, HIPAA, organizational policies, and applicable state and federal regulations
Monitor calls, CRM records, and member documentation for accuracy, completeness, professionalism, and compliance
Identify training and continuing education needs; support onboarding, mentoring, and transition to independent call handling
Complete performance evaluations, reviews, one-on-one meetings, and employee assessments
Communicate benefit, process, policy, regulatory, system, and operational changes to staff
Oversee SharePoint and other approved 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 Information Technology
Handle escalated member, provider, authorized representative, and internal staff concerns and facilitate timely, compliant resolutions
Identify and appropriately document and refer complaints, grievances, appeals, coverage concerns, and compliance issues
Work with the Manager or Director on departmental goals, performance standards, objectives, quality-improvement initiatives, and strategic priorities
Maintain confidentiality and protect personally identifiable information and protected health information
Review operational reports, quality findings, call-monitoring results, feedback, complaints, and compliance concerns to implement corrective or preventive actions
Manage employee schedules, attendance, timekeeping, paid-time-off requests, breaks, lunch adherence, and staffing coverage
Participate in recruitment, interviewing, selection, onboarding, and retention of Medicare Member Services representatives
Promote a professional, collaborative, inclusive, accountable, and member-focused work environment
Perform other duties as assigned

Requirements

What you’ll need

High school diploma or equivalent and three (3) years of experience working in a customer service call center environment and four (4) years of experience working in Medicare, Medicare Advantage, CMS, Medicaid, Dual Eligible Special Needs Plans (D-SNP), healthcare compliance, health plan operations, member services, or a related environment; OR associate’s degree and two (2) years of experience working in a customer service call center environment and three (3) years of experience working in Medicare, Medicare Advantage, CMS, Medicaid, Dual Eligible Special Needs Plans (D-SNP), healthcare compliance, health plan operations, member services, or a related environment
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 clearly and professionally
Ability to sit, stand, walk, and use standard office equipment for extended periods
Standard office environment
Required schedule: 12:00 p.m. to 8:00 p.m., Saturday through Wednesday; schedule subject to change based on departmental and operational needs

Benefits

Comp & perks

Full-time employment
40 scheduled weekly hours