Note: The job is a remote job and is open to candidates in USA. Mass General Brigham is a not-for-profit organization dedicated to advancing patient care, research, teaching, and community service. They are seeking a Medicare Member Service Representative responsible for providing exceptional customer service to Medicare beneficiaries, handling inquiries, resolving concerns, and offering guidance on benefits and claims.
Responsibilities
- Respond to inbound calls, emails, and inquiries from Medicare members, family members, and caregivers regarding coverage, eligibility, claims, and billing
- Assist members in understanding their Medicare plan benefits and how to access services within the healthcare network
- Document all member interactions accurately in customer service or call center systems
- Collaborate with departments such as billing, care management, and clinical teams to resolve complex member issues or escalations
- Educate members on preventive services, appointment scheduling, and care navigation resources
- Follow scripts, protocols, and compliance guidelines in accordance with Medicare and CMS regulations
- Maintain confidentiality and protect patient/member information per HIPAA guidelines
- Identify recurring concerns or patterns and escalate trends to leadership to improve processes
- Meet performance and quality metrics such as call volume, response time, and customer satisfaction scores
Skills
- High School Diploma or Equivalent required
- Experience in Customer Service, preferably in a healthcare, insurance, or call center setting 1-2 years required
- Strong understanding of Medicare benefits, claims processes, and CMS guidelines
- Excellent verbal and written communication skills
- Ability to remain calm and empathetic when dealing with frustrated or confused members
- Strong attention to detail, accuracy, and documentation
- Ability to multitask in a high-volume, fast-paced call center environment
- Proficient in Microsoft Office and call tracking software
- Associate's Degree Healthcare Administration preferred
- Associate's Degree Business preferred
- Associate's Degree Related Field of Study preferred
- Experience working with Medicare beneficiaries, healthcare billing, or insurance plans 0-1 year preferred
- Experience with CRM, call center software, or electronic health records (EHR) systems 0-1 year preferred
- Bilingual in Spanish, Haitian Creole, and Vietnamese preferred
Benefits
- In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.
- MGB-provided equipment
- Reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
- To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
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