Member Service Specialist Seasonal Position - MediGold
Member Service Specialist Seasonal Position - MediGold
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Job Description
Employment Type:
Full timeShift:
Description:
This is a Full Time temporary position. Temporary position until 4/4/2026Why MediGold
About the job:
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
What youll do:
- 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.
- Meets or exceeds Federal service level requirements for a Medicare Managed Care call center monitored by CMS or their appointed representatives.
- Outreach to members and providers to close gaps in care create and maintain relationships and obtain accurate information. Must be able to articulate and achieve desired outcomes.
- Achieve and maintain a superior (5-STAR) CMS rating in member/consumer satisfaction.
- Consistently document and accurately code all inquiries within designated software to reflect the purpose of a consumers inquiry and all actions taken to address and resolve their issue or need.
- Generate standard or customized letters and reports to accurately respond to inquiries as needed.
- To obtain and maintain a thorough knowledge of plan benefits services understanding of Federal rules and requirements and be able to communicate such knowledge to consumers effectively.
- Creates a positive and productive work environment that fosters a team spirit of collaboration and strategic development and consumer excellence within the organization.
What were looking for:
- Education: Minimum of high school education with some college level studies preferred
- Experience: Customer Service along with knowledge of governmental agencies and regulations especially Medicare and the Centers for Medicare and Medicaid Services (CMS) desired.
- Effective Communication Skills; consumer retention and strategic thinking.
- Demonstrated knowledge and effective organizing multi-tasks in a high volume fast-paced team environment.
- Knowledge of managed care benefit plans and products. Medical terminology and medical claims processing a plus.
Ministry/Facility Information:
Mount Carmel a member of Trinity Health has been a transforming healing presence in Central Ohio for over 135 years. 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. If youre seeking a rewarding career where your purpose passion and desire to make a difference come alive we invite you to consider joining our team. Here care is provided by all of us For All of You!
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race color sex age national origin religion sexual orientation gender identity status as a veteran and basis of disability or any other federal state or local protected class.
Our Commitment
Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. 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.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
