Medicare Member Services Representative

Location: Akron, OH 44305
Schedule: Monday–Friday, 8:00 AM–5:00 PM
Weekends: None
Pay:

• $22/hour – Health Insurance Licensed

• $20/hour – Not Health Insurance Licensed
  Interview Process: Microsoft Teams interview required
  Work Setting: In-office

Position Overview

We are seeking a Medicare Member Services Representative to provide personalized support to Medicare Advantage members by phone and in person. This role assists members with plan information, benefits, network and pharmacy questions, plan changes, and enrollment-related inquiries.

The ideal candidate will have at least 2 years of experience in the health insurance industry, including experience working with Medicare beneficiaries and Medicare/health insurance compliance requirements.

A health insurance license is preferred but not required.

Key Responsibilities

• Complete Medicare Advantage plan changes over the phone using compliance-approved scripts.

• Provide accurate information regarding Medicare Advantage plans, benefits, networks, pharmacies, and plan options.

• Assist Medicare beneficiaries in selecting the most appropriate plan based on their needs and preferences.

• Complete plan change requests between SummaCare MA-PD plans.

• Document member interactions and maintain accurate records.

• Track and follow up with Medicare members who may be at risk for disenrollment.

• Make outbound calls to members regarding plan, network, or benefit changes, particularly during the Annual Enrollment Period (AEP).

• Support member outreach and retention programs.

• Educate members and prospective enrollees about available plan options and enrollment requirements.

• Communicate plan information clearly and accurately to ensure members understand their available choices.

• Assist with tracking and monitoring plan change requests and related administrative activities.

• Support presentations of plan benefit information to groups or individuals as needed.

• Maintain reporting and database systems.

• Work closely with internal departments to coordinate member needs and complete projects.

• Follow all CMS regulations, Medicare marketing guidelines, company policies, and compliance requirements.

Required Qualifications

• High school diploma or GED required.

• Associate or bachelor's degree preferred.

• At least 2 years of experience in a call center, customer service, or support role within the health insurance industry.

• Experience working directly with Medicare beneficiaries required.

• Understanding of Medicare and health insurance compliance required.

• Working knowledge of Medicare, plan design, and health insurance benefits.

• Working knowledge of CMS rules and regulations related to Medicare Advantage plans.

• Health insurance license preferred but not required.

Skills & Qualifications

• Excellent telephone and customer service skills.

• Strong listening and critical-thinking abilities.

• Ability to explain complex insurance and Medicare information clearly.

• Strong attention to detail and documentation skills.

• Ability to multitask while navigating multiple computer systems.

• Comfortable working independently and as part of a team.

• Strong time-management and organizational skills.

• Ability to prioritize and complete assigned goals and projects.

• Ability to remain calm and build trust with members, including during difficult or stressful interactions.

• Ability to maintain strict compliance with federal and state regulations and Medicare marketing guidelines.

• Must be able to successfully complete required SummaCare plan and product training with a minimum passing score of 90%.

Technology

Candidates should be comfortable using multiple systems simultaneously while speaking with members, including:

• CRM systems such as Salesforce

• Member documentation systems

• Plan and benefit platforms

• Company websites and phone systems

• Microsoft Office and standard computer applications

Work Environment

This is a fully in-office position in Akron, Ohio, Monday through Friday, 8:00 AM–5:00 PM. No weekends are required.

The role involves frequent member interaction, occasional interruptions and distractions, and work that can be complex and detail-oriented. Candidates should be comfortable communicating with Medicare members and helping them navigate plan and enrollment questions with professionalism, patience, and accuracy.

Health insurance license is preferred but not required.