Medicare Advantage Customer Service Team Lead

Mass General Brigham•Somerville, MA

5d•$22 - $32•Remote

About The Position

Responsible for providing exceptional customer service to Medicare beneficiaries by handling inquiries, resolving concerns, and offering guidance on benefits, claims, billing, and enrollment. This role supports patients and members within a healthcare organization through phone-based, email, and in-person interactions, and plays a key role in ensuring a positive member experience.

Requirements

High School Diploma or Equivalent required
Experience in Customer Service, preferably in a healthcare, insurance, or call center setting 1-2 years required
Strong understanding of Medicare benefits, claims processes, and CMS guidelines.
Excellent verbal and written communication skills.
Ability to remain calm and empathetic when dealing with frustrated or confused members.
Strong attention to detail, accuracy, and documentation.
Ability to multitask in a high-volume, fast-paced call center environment.
Proficient in Microsoft Office and call tracking software.

Nice To Haves

Associate's Degree Healthcare Administration preferred
Associate's Degree Business preferred
Associate's Degree Related Field of Study preferred
Experience working with Medicare beneficiaries, healthcare billing, or insurance plans 0-1 year preferred
Experience with CRM, call center software, or electronic health records (EHR) systems 0-1 year preferred
Experience working with DSNP preferred

Responsibilities

Respond to inbound calls, emails, and inquiries from Medicare members, family members, and caregivers regarding coverage, eligibility, claims, and billing.
Assist members in understanding their Medicare plan benefits and how to access services within the healthcare network.
Document all member interactions accurately in customer service or call center systems.
Collaborate with departments such as billing, care management, and clinical teams to resolve complex member issues or escalations.
Educate members on preventive services, appointment scheduling, and care navigation resources.
Follow scripts, protocols, and compliance guidelines in accordance with Medicare and CMS regulations.
Maintain confidentiality and protect patient/member information per HIPAA guidelines.
Identify recurring concerns or patterns and escalate trends to leadership to improve processes.
Meet performance and quality metrics such as call volume, response time, and customer satisfaction scores.