Temporary - Member Service Specialist

Trinity Health•Columbus, OH

1d•Remote

About The Position

The Member Service Specialist responds to consumer inquiries by phone, in person, or in writing about plan benefits and services, organizational determinations, reconsiderations, complaints, and general questions. The role follows the rules and regulations governing Medicare Advantage plans and implements retention strategies to maintain membership and improve the quality of care and service. This is a temporary/seasonal position through April 2027. It is a remote opportunity with a Monday–Friday schedule of either 8:00 a.m.–4:30 p.m. or 8:30 a.m.–5:00 p.m. Eastern Time.

Requirements

Minimum high school education.
Effective communication skills.
Ability to organize and manage multiple tasks in a high-volume, fast-paced team environment.
Customer service experience and knowledge of governmental agencies and regulations, especially Medicare and CMS, are desired.

Nice To Haves

Some college-level studies.
Medicare Advantage, managed care, health insurance, customer service, or call center experience.
Knowledge of governmental agencies and regulations, especially Medicare and CMS.
Consumer retention and strategic-thinking skills.

Responsibilities

Comply with internal policies, CMS and Ohio Department of Insurance requirements, NCQA standards, and applicable federal regulations.
Understand the rules and audit protocols governing consumer service activities and demonstrate the ability to pass audits.
Meet or exceed individual and team service performance goals while complying with federal, state, and governing requirements.
Meet or exceed federal service-level requirements for a Medicare Managed Care call center monitored by CMS or its representatives.
Receive, interpret, and accurately answer consumer inquiries verbally and in writing in a positive, compassionate, and affirming manner while complying with federal regulations.
Contact members and providers to close gaps in care, build and maintain relationships, obtain accurate information, and achieve desired outcomes.
Identify consumers’ needs and provide a high level of service with measurable outcomes.
Use interpreting services to assist consumers with limited English proficiency and accurately provide answers through foreign-language interpreters.
Achieve and maintain a superior (5-STAR) CMS rating in member and consumer satisfaction.
Implement retention strategies to maintain current membership and improve quality of care and service.

Benefits

Competitive compensation and benefits packages, including medical, dental, and vision coverage starting on day one.
Retirement savings account with employer match starting on day one.
Generous paid time off programs.
Employee recognition programs.
Tuition and professional development reimbursement starting on day one.
100% paid RN-to-BSN tuition at Mount Carmel’s College of Nursing.
Relocation assistance, subject to geographic and position restrictions.
Employee Referral Rewards program.
DailyPay for eligible colleagues.
Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.