NEW JOB OPENING
MEDICARE CUSTOMER SERVICE REPRESENTATIVE
IN Remote, USA!

Required Education:

• High School Diploma or Equivalent



Preferred Education:

• Associate degree in a related field



Required Qualifications/Skills/Experience:

• Minimum 6 months of customer service, healthcare, pharmacy, call center, or related experience

• Strong verbal and written communication skills

• Ability to problem-solve and manage multiple variables in standardized situations

• Proficiency navigating multiple computer systems simultaneously in a Windows-based environment

• Typing speed of 30 WPM or greater

• Ability to work independently in a productivity-driven environment

• Ability to maintain accurate documentation and meet quality standards

• Wired internet connection with minimum speeds of 25 Mbps download and 5 Mbps upload



Preferred Qualifications/Skills/Experience:

• Call center experience

• Experience in a PBM, managed care, healthcare, or pharmacy environment

• Experience handling confidential patient or member information

• Familiarity with claims platforms, case management systems, and internal databases

• Previous remote work experience

• Pharmacy or medical background



Remote Medicare Customer Service Representative Overview:

• The Rep II, Operations role supports Medicare members, prescribers, and providers by processing coverage-related requests through both phone and fax channels

• This position combines responsibilities across multiple workflows and supports a modularized training approach where employees progressively learn and apply end-to-end operational processes before transitioning into full production responsibilities

• In this role, you will be responsible for accurate case setup, review, outreach, documentation, and timely resolution of requests while ensuring compliance with Medicare guidelines, CMS requirements, and internal quality standards

• The position requires strong attention to detail, excellent communication skills, and the ability to work effectively in a highly regulated and fast-paced environment

• The ideal candidate will be comfortable handling inbound and outbound phone interactions, reviewing documentation, gathering information from providers and members, and managing multiple systems simultaneously

• Employees will participate in ongoing coaching, training, and professional development to support operational excellence and continuous improvement



Job Duties:

• Process coverage-related requests, including prior authorizations, coverage determinations, drug benefit exceptions, and appeals

• Review documentation and accurately establish cases in applicable systems

• Interpret business correspondence, technical procedures, and Medicare regulations

• Conduct outbound calls to members and providers to obtain required information

• Communicate professionally and empathetically with members, providers, and internal stakeholders

• Document case activity accurately and completely across multiple systems

• Ensure compliance with CMS timelines, quality standards, and productivity expectations

• Research issues, identify errors, and support resolution efforts

• Escalate complex issues and clinical questions to appropriate teams when necessary

• Collaborate with peers, trainers, and leadership throughout training and production activities

• Maintain knowledge of evolving work instructions, systems, and Medicare guidance

• Participate in coaching, feedback, and professional development discussions

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**