Job Description

Job Description

Position Title: Customer Service Representative – Medicare

Location: Wheeling, WV

Employment Type: Contract (AEP Season)

Position Overview

The Customer Service Representative – Medicare is responsible for providing prompt and courteous support to members and providers, answering questions accurately, and ensuring a positive experience with each interaction. This role also manages timely completion of all correspondence, emails, faxes, voicemails, and reporting functions within the Customer Service Department.

This position is primarily scheduled for the 11:00 AM – 8:00 PM shift, with flexibility based on business needs, especially during the Annual Enrollment Period (AEP).

Key Responsibilities

• Answer 40–60 inbound calls per day from members and providers in a courteous, professional manner.
• Provide accurate and timely responses to member and provider questions regarding benefits, claims, and coverage.
• Complete all assigned correspondence, emails, faxes, voicemails, and reporting tasks promptly.
• Document all calls and interactions according to departmental guidelines.
• Meet or exceed performance expectations while maintaining a positive attitude and dependable attendance.

Required Qualifications

• High school diploma or equivalent (some college coursework in health or related fields preferred).
• Strong interpersonal skills
• Excellent verbal and written communication skills.
• Basic knowledge of the healthcare system.
• Proficiency with personal computers and keyboarding skills.
• Ability to use proper grammar and communicate clearly in English.
• Courteous, professional demeanor with even temperament.

Preferred Qualifications

• 1–2 years of college coursework in health or related field.
• Previous call center or customer service experience.
• Familiarity with:
• Medical terminology
• CPT and ICD-9/ICD-10 coding
• Medical and hospital claims processes
• Prescription coding (NDC)
• Coordination of Benefits rules

Success Factors

• Maintains professionalism, accuracy, and efficiency in a fast-paced environment.
• Consistently meets performance goals and adheres to departmental standards.
• Demonstrates flexibility in schedule to support peak periods, especially during AEP.
• Continues to improve job knowledge and contribute positively to team success.

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