[Hiring] Temporary - Member Service Specialist @Trinity Health

Role Description

*REMOTE OPPORTUNITY*

This position is temporary/seasonal through April 2027. The schedule is M-F, 8am-4:30pm or 8:30-5pm EST. Medicare Advantage experience would be helpful, managed care, health insurance, as well as customer service and call center experience.

In accordance with the Mission and Guiding Behaviors, the 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
• General inquiries

Implements retention strategies to maintain current membership and improve the quality of care and service.

What You Will Do:

• Comply 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 of consumer service activities and demonstrate the ability to pass audits of activities.
• Engage with consumers to effectively meet or exceed individual and team service performance goals in a compliant manner.
• Meet or exceed Federal service level requirements for a Medicare Managed Care call center monitored by CMS or their appointed representatives.
• Receive, interpret, and accurately respond to consumer inquiries, both verbally and in writing, in a positive, compassionate, and affirming manner while ensuring compliance with Federal regulations.
• Outreach to members and providers to close gaps in care, create and maintain relationships, and obtain accurate information.
• Discern the needs of consumers with a commitment to providing the highest level of service possible with measurable outcomes.
• Utilize interpreting services and accurately provide answers to consumers via foreign language interpreters to assist limited English speaking consumers.
• Achieve and maintain a superior (5-STAR) CMS rating in member/consumer satisfaction.

Qualifications

• 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.

Benefits

• Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
• Retirement savings account with employer match starting on day one.
• Generous paid time off programs.
• Employee recognition programs.
• Tuition/professional development reimbursement starting on day one.
• RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
• Relocation assistance (geographic and position restrictions apply).
• Employee Referral Rewards program.
• DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday.
• Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.

Company Description

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:

• 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!

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.