Medicare Member Service Representative

Work at Home

Job Description

Our Medicare Member Service Representatives are responsible for addressing member/subscriber/provider inquiries, questions and concerns in areas including enrollment, claims, benefit interpretation, and referrals/ authorizations. Qualified individuals will possess the ability to work in a fast-paced environment and deal with challenges inherent in a call-center atmosphere. The ideal candidate is motivated and accountable to self and the team, a problem-solver, takes feedback well, has excellent people skills, a positive attitude and enjoys working with people, striving to deliver excellent customer service on each call.


  • Responsible for verifying member coverages, benefit types, eligibility dates, and claim payment/statuses
  • Estimate member’s out of pocket expenses for select procedures or services and explain member copayments
  • Meet established performance goals in the areas of efficiency, call quality, customer satisfaction, first call resolution, adherence, and attendance
  • Ensure compliance with BroadPath, Client, and HIPAA regulations

Basic Qualifications

  • REQUIRED: Minimum of one year of recent experience as a Medicare Member Service Representative
  • Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
  • Strong computer and telephone multitasking skills including: the ability to effectively search for and type information on the computer, navigate through multiple windows and screens quickly, and inputting information accurately while keeping pace with the call
  • Requires excellent verbal and written communication skills

Preferred Qualifications

  • Previous Facets system experience
  • Previous Macess system experience