Medicare Customer Service Representative

Bloom is a third-party insurance services provider that partners with Medicare health plans. The Medicare Customer Service Representative helps members access care and community resources, responds to inbound calls, conducts outreach, and coordinates appointments and member support.

Responsibilities:

• Function as the first point of contact for our client's members
• Communicate with members in a courteous, respectful, and professional manner
• Demonstrate exceptional care and compassion for our members
• Field inbound calls, as well as conduct outbound calls for member outreach
• Provide first-call- resolution for member issues
• Escalate, document unresolved issues, and reroute them to the next level of support
• Follow communication scripts and use knowledge of the company’s products and services to support member needs
• Schedule member appointments as needed, provide status updates for prior authorization, handle member claims questions, and provide the member with an explanation of benefits
• Provide assistance with the replacement of member ID cards
• Conduct social determinates of health, and provide release assessments for members
• Maintain or exceed key performance indicators and quality performance based on established metrics
• Document all activities through appropriate systems and channels
• Empathize and remain patient with difficult callers
• Excellent attendance, along with consistent dependability and flexibility in the workplace
• Evaluate information to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery
• Complete required training and understand how to use tools available to recall necessary information and take appropriate action
• Consistently support Bloom’s compliance policies and maintain the privacy and confidentiality of information
• Develop an understanding of the way performance and actions affect Bloom’s Call Center performance initiatives (call handling, first call resolution, member retention, and performing proper follow-up as warranted)
• Utilize dual monitors and leverage computer-based resources to find answers to customer questions
• Must be able to work evenings and weekends, if needed
• Perform all other duties as assigned

Requirements:

• High school diploma or GED
• A minimum of 6 months of Medicare healthcare customer service experience required
• Excellent customer service skills
• Proficient computer skills
• Active listening and soft skills
• Critical thinking skills
• Ability to multi-task in a fast-paced environment
• Self-motivator
• Excellent verbal and written communication skills
• Ability to successfully handle a high volume of inbound and outbound phone outreaches
• Ability to hold a calm, respectful tone and professional demeanor while under pressure
• Performance-driven mindset
• A solutions-minded team player
• Positive can-do attitude
• Ability to meet or exceed established call center productivity metrics
• Ability to meet or exceed established goals on all call monitoring audits
• Ability to learn and navigate through multiple different systems
• Written and verbal fluency in Spanish language preferred