Employment Type:

Full time

Shift:

Description:

Why MediGold?

               

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re 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 consumer's 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 America’s 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 Carmel’s College of Nursing.

• Relocation assistance (geographic and position restrictions apply).

• Employee Referral Rewards program.

• Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!

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

Ministry/Facility Inform