Note: The job is a remote job and is open to candidates in USA. Leeds Professional Resources is seeking a Medicare/Medicaid Customer Support Representative to join its customer service and call center team. The role handles member inquiries about benefits, eligibility, claims, enrollment, and provider networks, with onsite training in Tampa followed by remote work after successful completion of training.
Responsibilities
- Handle a high volume of inbound customer calls regarding Medicare and Medicaid plans
- Provide accurate information regarding benefits, eligibility, coverage, claims, authorizations, and provider networks
- Assist members with enrollment, plan changes, renewals, and general inquiries
- Research and resolve customer concerns while maintaining a high level of professionalism and empathy
- Document all customer interactions accurately within CRM and healthcare systems
- Meet or exceed established quality assurance, productivity, attendance, and customer satisfaction metrics
- Escalate complex member concerns following company procedures
- Maintain confidentiality of Protected Health Information (PHI) in compliance with HIPAA regulations
- Navigate multiple computer systems while speaking with members
- Stay current on Medicare, Medicaid, CMS guidelines, and company policies
- Participate in ongoing training and quality improvement initiatives
Skills
- Minimum 3 years of recent Medicare and/or Medicaid customer service experience in a call center environment
- High school diploma or GED required
- Strong understanding of:
- Medicare Parts A, B, C, and D
- Medicaid eligibility and benefits
- Claims processing
- Prior authorizations
- Member enrollment
- Provider networks
- Excellent verbal and written communication skills
- Strong problem-solving and conflict resolution abilities
- Ability to manage multiple systems while maintaining call quality
- Proficiency with Microsoft Office and customer relationship management (CRM) software
- Ability to work independently in a remote environment after training
- Associate's or Bachelor's degree
- Experience supporting Medicare Advantage or Managed Medicaid plans
- Experience working for a health insurance carrier, managed care organization (MCO), or third-party administrator (TPA)
- Bilingual (English/Spanish) preferred but not required
Benefits
- Fully remote work environment after successful completion of 2–3 months of onsite training in Tampa, FL
- Ongoing training and quality improvement initiatives
Company Overview