Medicare Advantage Customer Service Team Lead

Mass General Brigham is a not-for-profit healthcare organization supporting patient care, research, teaching, and community service. The Medicare Advantage Customer Service Team Lead provides exceptional service to Medicare beneficiaries by handling inquiries, resolving concerns, and offering guidance on benefits, claims, billing, and enrollment. The role documents member interactions, collaborates on complex issues, supports care navigation, and follows Medicare, CMS, and HIPAA requirements.

Responsibilities:

• Respond to inbound calls, emails, and inquiries from Medicare members, family members, and caregivers regarding coverage, eligibility, claims, and billing
• Assist members in understanding their Medicare plan benefits and how to access services within the healthcare network
• Document all member interactions accurately in customer service or call center systems
• Collaborate with departments such as billing, care management, and clinical teams to resolve complex member issues or escalations
• Educate members on preventive services, appointment scheduling, and care navigation resources
• Follow scripts, protocols, and compliance guidelines in accordance with Medicare and CMS regulations
• Maintain confidentiality and protect patient/member information per HIPAA guidelines
• Identify recurring concerns or patterns and escalate trends to leadership to improve processes
• Meet performance and quality metrics such as call volume, response time, and customer satisfaction scores

Requirements:

• High School Diploma or Equivalent required
• Experience in Customer Service, preferably in a healthcare, insurance, or call center setting 1-2 years required
• Strong understanding of Medicare benefits, claims processes, and CMS guidelines
• Excellent verbal and written communication skills
• Ability to remain calm and empathetic when dealing with frustrated or confused members
• Strong attention to detail, accuracy, and documentation
• Ability to multitask in a high-volume, fast-paced call center environment
• Proficient in Microsoft Office and call tracking software
• M-F 8:30AM - 5PM EST business hours required for remote role
• A quiet, secure, stable, HIPPA-compliant workstation is required
• Associate's Degree preferred
• Experience working with Medicare beneficiaries, healthcare billing, or insurance plans 0-1 year preferred
• Experience with CRM, call center software, or electronic health records (EHR) systems 0-1 year preferred
• Experience working with DSNP preferred