Overview

BroadPath is hiring a team of work-from-home Medicare Member Service Representatives . This role is pivotal in ensuring direct and timely communication between the Plan and its members, potential members, providers, employer groups, brokers, internal departments, and external agencies. It requires a high level of knowledge about Medicare Healthcare Plans products, premiums, benefits, and procedures. The representative will use their judgment to assist callers appropriately and provide accurate problem-solving through research and resolution of concerns.

Responsibilities

Communication and Support:

• Handle inquiries from members, potential members, brokers, employer groups, and other stakeholders

• Verify prescription drug eligibility, benefits, claims, and authorizations

• Assist members in understanding health coverage, enrollment materials, and provider networks

• Document and forward member concerns, complaints, and appeals

Compliance and Documentation:

• Comply with healthcare practices, policies, and ethical standards

• Utilize handbooks, Evidence of Coverage, supplemental benefit information, and other resources to provide accurate information

Problem Resolution:

• Identify and recommend solutions for operational problems

• Maintain an organized work area and use reference materials effectively

• Ensure compliance with regulatory and accreditation requirements, including DMHC, CMS, and NCQA on all calls

Project Participation:

• Work on projects assigned by the supervisor, such as new member orientation, premium billing reminders, member education, claims investigation, and more

Collaboration:

• Work collaboratively with other internal departments, such as enrollments, provider inquiries, and any department to quickly resolve customer concerns or issues

• Assist with premium and billing questions and process ACH and credit card payments over the phone

Qualifications

• High school diploma or equivalent

• Minimum 6 months experience as Call Center Representative

• 2 years of recent Medicare customer service or Medicare in-office experience

• Strong interpersonal skills and sound judgment

• Knowledge of health maintenance organizations, performance management, and customer satisfaction

• Basic computer and writing skills

Preferred Experience:

• Epic database experience

• AA in Business or Health Care Administration

Diversity Statement

At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation!

Equal Employment Opportunity/Disability/Veterans

If you need accommodation due to a disability, please email us at HR@Broad-path.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process

BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law.

Compensation: BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.