Medicare Customer Service Representative

Job Summary

To support Medicare members and providers, the full-time Remote Medicare Customer Service Representative will process coverage-related requests, manage case documentation, and ensure compliance with Medicare guidelines while working in a fast-paced environment.

Key responsibilities

• Process coverage-related requests, including prior authorizations and appeals, through phone and fax channels
• Review documentation and accurately establish cases in applicable systems while ensuring compliance with CMS timelines and quality standards
• Communicate professionally with members and providers, gathering necessary information and documenting case activity across multiple systems

Required qualifications

• High School Diploma or equivalent; Associate's Degree preferred
• Minimum of 6 months of customer service experience in healthcare, pharmacy, or call center environments
• Proficiency in navigating multiple computer systems in a Windows-based environment
• Typing speed of 30 WPM or greater
• Experience handling confidential patient or member information