Why MediGold?
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
About the job:
Member Service Representative responds to all consumer inquiries received by phone, in person or in writing regarding product plan benefits, services, organizational determinations, reconsiderations, complaints and general inquiries in accordance with the rules and regulations of a Medicare Advantage plan and governing agencies. Implements retention strategies to maintain current membership and improve the quality of care and service
What you'll do:
- Complies with internal policies, Center for Medicare and Medicaid Services (CMS), Ohio Department of Insurance (ODI), NCQA and all applicable Federal regulations.
- Develop a thorough understanding of the applicable rules and audit protocols that govern all aspects consumer service activities and demonstrated ability to pass audits of activities.
- Meets or exceeds Federal service level requirements for a Medicare Managed Care call center monitored by CMS or their appointed representatives.
- Outreach to members and providers to close gaps in care, create and maintain relationships and obtain accurate information. Must be able to articulate and achieve desired outcomes.
- Achieve and maintain a superior (5-STAR) CMS rating in member/consumer satisfaction.
- Consistently document and accurately code all inquiries within designated software to reflect the purpose of a consumer's inquiry and all actions taken to address and resolve their issue or need.
- Generate standard or customized letters and reports to accurately respond to inquiries as needed.
- To obtain and maintain a thorough knowledge of plan benefits, services, understanding of Federal rules and requirements and be able to communicate such knowledge to consumers effectively.
- Creates a positive and productive work environment that fosters a team spirit of collaboration and strategic development and consumer excellence within the organization.
What we're looking for:
- Education: Minimum of high school education with some college level studies preferred
- Experience: Customer Service along with knowledge of governmental agencies and regulations, especially Medicare and the Centers for Medicare and Medicaid Services (CMS) desired.
- Effective Communication Skills; consumer retention and strategic thinking.
- Demonstrated knowledge and effective organizing multi-tasks, in a high volume, fast-paced team environment.
- Knowledge of managed care benefit plans and products. Medical terminology and medical claims processing a plus.
Ministry/Facility Information:
Mount Carmel, a member of Trinity Health, has been a transforming healing presence in Central Ohio for over 135 years. Mount Carmel serves over 1.3 million patients each year at our five hospitals, free-standing emergency centers, outpatient facilities, surgery centers, urgent care centers, primary care and specialty care physician offices, community outreach sites and homes across the region. Mount Carmel College of Nursing offers one of Ohio's largest undergraduate, graduate, and doctor of nursing programs. If you’re seeking a rewarding career where your purpose, passion, and desire to make a difference come alive, we invite you to consider joining our team. Here, care is provided by all of us For All of You!
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
