Employment Type:

Shift:

Description:

Why MediGold

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. Were dedicated to providing excellent customer service cost-effective care and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology financial analysis audit provider relations and more.

We know that exceptional patient care starts with taking care of our colleagues so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.

Position Purpose:

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 You Will 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.

• 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.

• 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.

• 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.

• 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.

Minimum Qualifications:

• 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.

• PC proficient including word-processing data entry Microsoft office and various software.

• Medical terminology and medical claims processing a plus.

Position Highlights and Benefits:

• Mount Carmel Health System recognized by Forbes in 2025 as one of Americas Best State Employers.

• 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.

• Generous paid time off programs.

• Employee recognition programs.

• Tuition/professional development reimbursement starting on day one.

• RN to BSN tuition 100% paid at Mount Carmels College of Nursing.

• Relocation assistance (geographic and position restrictions apply).

• Employee Referral Rewards program.

• Mount Carmel offers DailyPay - if youre hired as an eligible colleague youll be able to see how much youve made every day and transfer your money any time before deserve to get paid every day!

• Opportunity to join Diversity Equity and Inclusion Colleague Resource Groups.

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.