<h3>Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. </h3>Come join our <a href="https://himalayas.app/companies/peak-health">Peak Health</a> team at WVU Medicine as a Member Services Representative, contributing to the foundation for an innovative, Peak Advantage Medicare plan. The Medicare Membership Services Representative will take inbound calls from <a href="https://himalayas.app/companies/peak-health">Peak Health</a> Medicare Advantage members, and providers answering questions ranging from general information to complex inquires on a wide range of issues. This role will work with management and peers on the Peak team to research and resolve member issues and questions. In addition to taking inbound calls, will make outbound calls to members and providers with issue resolution or to gather further information. Candidates should expect to work an 8-hour shift, between the hours of 7:30 am – 8:00 pm Monday – Friday.<h3><u>MINIMUM QUALIFICATIONS</u><b>:</b></h3><h3><b>EDUCATION, CERTIFICATION, AND/OR LICENSURE:</b></h3><h3><b>1. High School diploma or equivalent</b></h3><h3><b>EXPERIENCE:</b></h3><p><b>1. One (1) year of experience with handling Medicare claims or related experience</b></p><h3><b><u>PREFERRED QUALIFICATIONS</u></b><b>:</b></h3><h3><b>EDUCATION, CERTIFICATION, AND/OR LICENSURE:</b></h3><p><b>1. Associate Degree, or greater, in related healthcare field.</b></p><h3><b>EXPERIENCE:</b></h3><p><b>1. Three (3) plus years’ experience in a fast-paced call environment with processing and/or customer service experience.</b></p><p><b>2. Two (2) years’ experience in Medicare benefits</b></p><p><b>3. Two (2) years’ experience in knowledge of CMS guidelines</b></p><p><b>4. Experience supporting Dual Eligible Special Needs Plans (D-SNP), including working knowledge of Medicaid benefits, care coordination, eligibility requirements, and the integration of Medicare and Medicaid services to support complex member needs.</b></p><p><b>5. Experience assisting members with D-SNP eligibility determinations, enrollment processes, benefit-related inquiries, and navigation of Medicare and Medicaid resources to ensure an exceptional member experience.</b></p><p><b><b>CORE DUTIES AND RESPONSIBILITIES: </b>The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.</b></p><p><b>1. Verify member information while addressing general questions.</b></p><p><b>2. Responds to and resolves all issues/inquires to assure an efficient and seamless member experience. </b></p><p><b>3. Maintains open channels of member communications doing outreach a