Customer Service Representative

Position Title: Medicare/Medicaid Customer Support Representative (Remote After Training)

Location: Tampa, Florida (Training Onsite; Fully Remote After Successful Completion of Training)

Department: Customer Service / Call Center

Reports To: Customer Service Supervisor

Position Summary

We are seeking an experienced Medicare/Medicaid Customer Support Representative to join our customer service team. This position requires a minimum of three (3) years of experience supporting Medicare and/or Medicaid members in a high-volume call center environment. During the first 23 months , employees will complete onsite training in Tampa, FL before transitioning to a fully remote work environment based on performance, attendance, and successful completion of training.

The ideal candidate is knowledgeable about Medicare and Medicaid benefits, enrollment processes, eligibility requirements, claims, and member services while delivering exceptional customer care in a fast-paced environment.

Key Responsibilities

• Handle a high volume of inbound customer calls regarding Medicare and Medicaid plans.
• Provide accurate information regarding benefits, eligibility, coverage, claims, authorizations, and provider networks.
• Assist members with enrollment, plan changes, renewals, and general inquiries.
• Research and resolve customer concerns while maintaining a high level of professionalism and empathy.
• Document all customer interactions accurately within CRM and healthcare systems.
• Meet or exceed established quality assurance, productivity, attendance, and customer satisfaction metrics.
• Escalate complex member concerns following company procedures.
• Maintain confidentiality of Protected Health Information (PHI) in compliance with HIPAA regulations.
• Navigate multiple computer systems while speaking with members.
• Stay current on Medicare, Medicaid, CMS guidelines, and company policies.
• Participate in ongoing training and quality improvement initiatives.

Required Qualifications

• Minimum 3 years of recent Medicare and/or Medicaid customer service experience in a call center environment.
• High school diploma or GED required.
• Strong understanding of:
• Medicare Parts A, B, C, and D
• Medicaid eligibility and benefits
• Claims processing
• Prior authorizations
• Member enrollment
• Provider networks
• Excellent verbal and written communication skills.
• Strong problem-solving and conflict resolution abilities.
• Ability to manage multiple systems while maintaining call quality.
• Proficiency with Microsoft Office and customer relationship management (CRM) software.
• Ability to work independently in a remote environment after training.

Preferred Qualifications

• Associate's or Bachelor's degree.
• Experience supporting Medicare Advantage or Managed Medicaid plans.
• Experience working for a health insurance carrier, managed care organization (MCO), or third-party administrator (TPA).
• Bilingual (English/Spanish) preferred but not required.