Medicare Customer Service Representative

Bloom•Bloomington, IN

9d•Remote

About The Position

Bloom is seeking an experienced Medicare Customer Service Representative to support members of its client health plans. The representative serves as a first point of contact, helping members access care and community resources, arrange transportation, and navigate plan services. The role conducts outreach to complete initial health screenings and schedule initial visits for newly enrolled members, while also handling inbound calls in a call center-like queue and outbound member calls. The representative responds to member questions and concerns, works to resolve issues on the first call, and escalates or routes unresolved matters as appropriate. The role also handles appointment scheduling, prior authorization status updates, claims questions, explanations of benefits, replacement ID card assistance, social determinants of health activities, and release assessments. Representatives document activity, protect member privacy, complete required training, and meet established service, productivity, and quality metrics. This position is remote. Employees must be able to work evenings and weekends if needed. Bloom describes a people-first culture with competitive compensation, comprehensive health coverage, long-term growth opportunities, and employee training, engagement, mentorship, and leadership programs.

Requirements

High school diploma or GED.
At least 6 months of Medicare healthcare customer service experience.
Excellent customer service, active listening, and interpersonal skills.
Proficient computer skills and ability to learn and navigate multiple systems.
Critical thinking and multitasking ability in a fast-paced environment.
Excellent verbal and written communication skills.
Ability to handle a high volume of inbound and outbound calls.
Ability to maintain a calm, respectful, professional demeanor under pressure.
Ability to meet or exceed call center productivity metrics and call-monitoring audit goals.
Self-motivated, performance-driven, solutions-minded team player with a positive attitude.
Dependable attendance and flexibility in the workplace.
Ability to work evenings and weekends if needed.

Nice To Haves

Written and verbal fluency in Spanish.

Responsibilities

Serve as the first point of contact for client members and communicate courteously, respectfully, and professionally.
Handle inbound calls and conduct outbound member outreach.
Provide first-call resolution for member issues; evaluate complaints, coordinate service recovery, and escalate, document, or reroute unresolved issues.
Use communication scripts and knowledge of company products and services to support member needs.
Schedule member appointments and initial visits for newly enrolled members.
Provide prior authorization status updates, answer claims questions, explain benefits, and assist with replacement member ID cards.
Help members access care and community resources and arrange transportation.
Conduct initial health screenings, social determinants of health activities, and release assessments.
Maintain or exceed established key performance indicators and quality metrics, including call handling, first-call resolution, member retention, follow-up, productivity, and call-monitoring goals.
Document activities in appropriate systems and channels.
Complete required training and use available tools and multiple systems to find information and take appropriate action.
Maintain member privacy and confidentiality and comply with Bloom policies.
Remain patient and empathetic with difficult callers and maintain dependable attendance and flexibility.
Use dual monitors and computer-based resources to answer member questions.
Perform other duties as assigned.