We are seeking a knowledgeable and customer-focused Medicare Customer Service Representative to assist members, providers, and caregivers with Medicare-related inquiries. The ideal candidate will demonstrate excellent communication skills, a strong understanding of Medicare guidelines, and the ability to provide accurate information and empathetic support.

• Respond to inbound calls, emails, or chats from Medicare members, providers, and caregivers regarding benefits, claims, eligibility, and coverage.
• Explain Medicare plans, services, and options in a clear and professional manner.
• Assist customers with billing inquiries, appeals, grievances, and prior authorizations.
• Accurately document all interactions in the customer relationship management (CRM) system.
• Ensure compliance with Centers for Medicare & Medicaid Services (CMS) regulations and company policies.
• Provide guidance on enrollment periods, plan changes, and Medicare Advantage/Part D benefits.
• De-escalate complex or sensitive issues with empathy and professionalism.
• Collaborate with internal departments to resolve customer concerns efficiently.
• Meet or exceed quality assurance, call handling, and customer satisfaction metrics.

• College graduate with other without BPO experience 
• 2 years college undergraduate completed with 6 months work experience
• No pending application to Sagility/HGS
• Resume required