Reference #: JR24-30406Welcome! 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.

　　Come join our Peak Health 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 Peak Health 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.

　　MINIMUM QUALIFICATIONS:EDUCATION, CERTIFICATION, AND/OR LICENSURE:1. High School diploma or equivalentEXPERIENCE:1. One (1) year of experience with handling Medicare claims or related experience

　　PREFERRED QUALIFICATIONS:EDUCATION, CERTIFICATION, AND/OR LICENSURE:1. Associate Degree, or greater, in related healthcare field.EXPERIENCE:1. Three plus years' experience in a fast-paced call environment with processing and/or customer service experience.2. Two years' experience in Medicare benefits3. Two years' experience in knowledge of CMS guidelines

　　CORE DUTIES AND RESPONSIBILITIES: 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.

　　Verify member information while addressing general questions.Responds to and resolves all issues/inquires to assure an efficient and seamless member experience.Maintains open channels of member communications doing outreach as required.Understanding of Medicare claims processing, and related inquiries.Meets all production and quality standards, maintaining work queues according to department standards.Effectively communicates with internal and external staff.Elevates issues to next level of supervision, as appropriate.Ensures accuracy of information gathered and shared on a member's behalf.Attends all required training classes, demonstrating proficiency and ability to learn.Other duties as deemed appropriate by the Management Team.Maintain accurate documents, including timekeeping recordsPHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

　　Ability to sit for extended periods of time.Ability to answer phone calls for extended periods of time.Lifting 10-25 lbs.Travel Requirement: 0%-25%WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

　　Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)Computer Software/Systems include but not limited to Microsoft Office Professional Suite (Outlook, Word, Excel, Access) Internet Explorer and EPICSKILLS AND ABILITIES:

　　Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.Abil ty to take direction and to navigate through multiple systems simultaneously.Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette.Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction.Familiarity with Medical insurance services process.Requires exceptional attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.Ability to work remotely - this includes reliability, self-motivation, focus & time management skills.Additional Job Description:

　　Scheduled Weekly Hours:40

　　Shift:

　　Exempt/Non-Exempt:United States of America (Non-Exempt)

　　Company:PHH Peak Health Holdings

　　Cost Center:2501 PHH Risk Admin

　　Address:Pennsylvania State

　　Harrisburg

　　Pennsylvania

　　Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

　　The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)