Medicare Member Service Representative
Job Location:
Somerville, NJ - USA
Hourly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Responsible for providing exceptional customer service to Medicare beneficiaries by handling inquiries resolving concerns and offering guidance on benefits claims billing and enrollment. This role supports patients and members within a healthcare organization through phone-based email and in-person interactions and plays a key role in ensuring a positive member experience.Essential Functions:
-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.
Qualifications
Education
- High School Diploma or Equivalent required
- Associates Degree Healthcare Administration preferred or Associates Degree Business preferred or Associates Degree Related Field of Study preferred
Experience
- Experience in Customer Service preferably in a healthcare insurance or call center setting 1-2 years required
- 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
Knowledge Skills and Abilities
- 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.
Additional Job Details (if applicable)
Mandatory Working Model:
Monday - Friday EST hours:
Training Schedule: M-F 8:30 AM 5:00 PM EST
Post-training Schedule shift will range between the following:8:00 AM - 4:30 PM EST 8:30 AM - 5 PM EST 9:00 AM - 5:30 PM EST or 11:30 AM - 8:00 PM EST
This is a remote position; a quiet secure stable and compliant work station is required from within the US with MGB-provided equipment and Video required during the work week
Start Date required: August 24 2026
An on-camera video interview is required to be considered for the position
Remote Type
Work Location
Pay Range
$22.22 - $31.71/HourlyGrade
4EEO Statement:
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Unclear Seniority
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
