Medicare Member Services Rep

Job Description

Job Description

A-Line Staffing is now hiring Medicare Member Services Representative (Remote). The Medicare Member Services Representative would be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.

• The start date is likely 10/5

Medicare Member Services Representative Compensation

• The pay for this position is $20.27 per hour
• Benefits are available to full-time employees after 90 days of employment
• A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates

Medicare Member Services Representative Highlights

• This position is a contract assignment with potential to hire on permanently based upon attendance, performance, and business needs
• This is a fully remote position
• The required availability for this position is Monday-Friday with schedule flexibility between 7:00 AM - 8:00 PM CST. Rotating weekend or holiday coverage may be required based on business needs.
• A dedicated, secure, and quiet home workspace is required
• Reliable high-speed internet with the ability to hard-wire into company equipment is required (no wireless connection or hotspots)

Medicare Member Services Representative Responsibilities

• Support Medicare members, prescribers, and providers by processing coverage-related requests through phone and fax channels.
• Handle requests related to prior authorizations, coverage determinations, drug benefit exceptions, and appeals.
• Accurately review documentation, set up cases, and process requests according to Medicare guidelines, CMS requirements, and internal procedures.
• Conduct inbound and outbound calls with members and providers to gather additional information and assist with request resolution.
• Provide clear, professional, and empathetic communication while assisting members with coverage-related questions.
• Document all case activity accurately across multiple systems while maintaining confidentiality of member information.
• Research and resolve issues related to coverage requests, eligibility, and processing errors.
• Ensure requests are completed within required timelines while meeting quality and productivity standards.
• Collaborate with internal teams and leadership to resolve complex issues and support member needs.

Medicare Member Services Representative Requirements

• High School Diploma or GED required
• Minimum of 6 months of healthcare, pharmacy, call center, or related experience
• Strong verbal and written communication skills
• Ability to navigate multiple computer systems simultaneously in a Windows-based environment
• Strong attention to detail and accuracy
• Ability to research information, identify issues, and determine appropriate solutions
• Ability to manage multiple tasks in a fast-paced environment
• Typing ability of 30 WPM or greater
• Ability to work independently in a remote environment
• Attendance is mandatory for the first 90 days

Medicare Member Services Representative Preferred Qualifications

• Call center experience
• Experience working in healthcare, Medicare, pharmacy benefits management (PBM), or managed care
• Experience handling confidential patient/member information
• Experience with prior authorizations, claims, benefits, or coverage reviews
• Familiarity with healthcare systems and multi-system workflows
• Pharmacy Technician Certification (CPhT) or related pharmacy experience
• Associate degree in Business, Accounting, Healthcare, or equivalent work experience

If you think this Medicare Member Services Representative position is a good fit for you, please apply to this posting!