Medicare Member Engagement Representative

Medicare Member Engagement Representative

The Medicare Member Engagement Representative serves as a primary point of contact for Medicare beneficiaries, providing guidance on health plan options, enrollment changes, benefits, and coverage-related inquiries. This role is responsible for delivering exceptional customer service, supporting member retention efforts, educating members on available healthcare options, and ensuring compliance with Medicare regulations and organizational policies.

Key Responsibilities

• Assist Medicare beneficiaries with health plan selections, enrollment changes, and benefit-related inquiries using approved compliance guidelines.
• Provide personalized support regarding plan benefits, provider networks, pharmacy coverage, and enrollment options.
• Conduct inbound and outbound member outreach to communicate plan updates, coverage changes, and enrollment opportunities.
• Support member retention initiatives through proactive follow-up and engagement activities.
• Educate members and prospective enrollees on Medicare plan options and available benefits.
• Accurately document member interactions within CRM and member management systems.
• Process enrollment transactions and plan change requests in accordance with established procedures.
• Track and monitor enrollment activities to ensure timely completion and accuracy.
• Maintain compliance with CMS regulations, Medicare guidelines, and company policies.
• Assist with reporting, administrative tasks, and database maintenance.
• Collaborate with internal departments to resolve member concerns and deliver a positive customer experience.

Required Qualifications

Education

• High School Diploma or GED required.
• Associate's degree or Bachelor's degree preferred.

Experience

• Minimum of two (2) years of experience in a call center, customer service, or support role within the health insurance industry.
• Experience working directly with Medicare beneficiaries is required.
• Strong understanding of Medicare regulations, health insurance compliance, and Medicare plan benefits.
• Previous healthcare or health insurance industry experience strongly preferred.

Preferred Qualifications

• Active Health Insurance License preferred but not required.
• Candidates with an active Health Insurance License may qualify for higher compensation.

Skills & Competencies

• Working knowledge of CMS regulations and Medicare Advantage programs.
• Excellent customer service, communication, and phone skills.
• Strong listening, problem-solving, and critical-thinking abilities.
• Ability to manage multiple tasks and systems simultaneously in a fast-paced environment.
• Strong organizational skills and attention to detail.
• Ability to work independently and collaboratively within a team setting.
• Experience utilizing CRM platforms, enrollment systems, and Microsoft Office applications.
• Ability to build trust and rapport with Medicare members while maintaining professionalism and compliance.
• Strong time-management skills and ability to prioritize competing responsibilities.