Temporary - Member Service Specialist

Trinity Health · Remote, United States

Employment Type:

Full time

Shift:
Day Shift
REMOTE OPPORTUNITY*
This position is temporary/seasonal through April 2027. Medicare Advantage experience would be helpful, managed care, health insurance, as well as customer service and call center experience.

the

Member Service Representative

responds to all consumer inquiries received by phone, in person or in writing regarding product plan benefits, services, organizational determinations, reconsiderations, complaints and general inquiries in accordance with the rules and regulations of a Medicare Advantage plan and governing agencies. Implements retention strategies to maintain current membership and improve the quality of care and service.
Complies with internal policies, Center for Medicare and Medicaid Services (CMS), Ohio Department of Insurance (ODI), NCQA and all applicable Federal regulations.

~ Develop a thorough understanding of the applicable rules and audit protocols that govern all aspects consumer service activities and demonstrated ability to pass audits of activities.

~ Engages with consumers to effectively meet or exceed individual and team service performance goals in a manner that is compliant with all Federal, State and governing requirements.

~ Meets or exceeds Federal service level requirements for a Medicare Managed Care call center monitored by CMS or their appointed representatives.

~ Receive, interpret and accurately respond to consumer inquiries, both verbally and in writing in ways that reflect a positive, compassionate and affirming manner while ensuring compliance with Federal regulations.

~ Outreach to members and providers to close gaps in care, create and maintain relationships and obtain accurate information. To discern the needs of consumers with commitment to providing the highest level of service possible with measurable outcomes.

~ Utilize interpreting services and accurately provide answers to consumers via foreign language interpreters to assist limited English speaking consumers.

~ Achieve and maintain a superior (5-STAR) CMS rating in member/consumer satisfaction.

Experience: Customer Service along with knowledge of governmental agencies and regulations, especially Medicare and the Centers for Medicare and Medicaid Services (CMS) desired.

~ Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.

~ Retirement savings account with employer match starting on day one.

~ Tuition/professional development reimbursement starting on day one.

~ Relocation assistance (geographic and position restrictions apply).

~ Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Ministry/Facility Information:
Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohios largest undergraduate, graduate, and doctor of nursing programs. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.