Customer Service Representative

<p><strong>Position Title:</strong> Medicare/Medicaid Customer Support Representative (Remote After Training)</p><p><strong>Location:</strong> Tampa, Florida (Training Onsite; Fully Remote After Successful Completion of Training)</p><p><strong>Department:</strong> Customer Service / Call Center</p><p><strong>Reports To:</strong> Customer Service Supervisor</p><p><br /></p><p><strong>Position Summary</strong></p><p>We are seeking an experienced <strong>Medicare/Medicaid Customer Support Representative</strong> to join our customer service team. This position requires a minimum of <strong>three (3) years of experience</strong> supporting Medicare and/or Medicaid members in a high-volume call center environment. During the first <strong>2–3 months</strong>, employees will complete onsite training in <strong>Tampa, FL</strong> before transitioning to a fully remote work environment based on performance, attendance, and successful completion of training.</p><p>The ideal candidate is knowledgeable about Medicare and Medicaid benefits, enrollment processes, eligibility requirements, claims, and member services while delivering exceptional customer care in a fast-paced environment.</p><p>Key Responsibilities</p><ul><li>Handle a high volume of inbound customer calls regarding Medicare and Medicaid plans.</li><li>Provide accurate information regarding benefits, eligibility, coverage, claims, authorizations, and provider networks.</li><li>Assist members with enrollment, plan changes, renewals, and general inquiries.</li><li>Research and resolve customer concerns while maintaining a high level of professionalism and empathy.</li><li>Document all customer interactions accurately within CRM and healthcare systems.</li><li>Meet or exceed established quality assurance, productivity, attendance, and customer satisfaction metrics.</li><li>Escalate complex member concerns following company procedures.</li><li>Maintain confidentiality of Protected Health Information (PHI) in compliance with HIPAA regulations.</li><li>Navigate multiple computer systems while speaking with members.</li><li>Stay current on Medicare, Medicaid, CMS guidelines, and company policies.</li><li>Participate in ongoing training and quality improvement initiatives.</li></ul><p><br /></p><p><strong>Required Qualifications</strong></p><ul><li>Minimum <strong>3 years of recent Medicare and/or Medicaid customer service experience</strong> in a call center environment.</li><li>High school diploma or GED required.</li><li>Strong understanding of:</li><li>Medicare Parts A, B, C, and D</li><li>Medicaid eligibility and benefits</li><li>Claims processing</li><li>Prior authorizations</li><li>Member enrollment</li><li>Provider networks</li><li>Excellent verbal and written communication skills.</li><li>Strong problem-solving and conflict resolution abilities.</li><li>Ability to manage multiple systems while maintaining call quality.</li><li>Proficiency with Microsoft Office and customer relationship management (CRM) software.</li><li>Ability to work independently in a remote environment after training.</li></ul><p><strong>Preferred Qualifications</strong></p><ul><li>Associate's or Bachelor's degree.</li><li>Experience supporting Medicare Advantage or Managed Medicaid plans.</li><li>Experience working for a health insurance carrier, managed care organization (MCO), or third-party administrator (TPA).</li><li>Bilingual (English/Spanish) preferred but not required.</li></ul><p><br /></p><p><br /></p>