Customer Service Lead Representative

Job Title: Customer Service Lead Representative
Location: Fully remote (open to all US continental states)
Duration: 9+ Months contract

Pay range: $22/hr on w2

Shift time: Standard shift (Must be able to work a flexible work schedule that may include Saturday as a normal workday or a holiday weekend on a rotating basis)
 
Job Purpose:

• This position is responsible for receipt and coordination of CMS MA-PD and PDP escalated complaints; submission of member and marketing materials to CMS for Client’s Medicare Advantage and Prescription Drug Plans;
• Applying CMS regulations pertaining to Medicare Advantage and Prescription Drug Plans to the review of member and marketing materials prior to submission to CMS; providing assistance and guidance regarding Medicare Advantage and Prescription Drug Plan regulations to Client staff;
• Working with other areas of the organization on the development, testing and implementation of organization, process and system changes to ensure the requirements of the Medicare Advantage and Prescription Drug program are met;
• Assisting MCO in coordination of the contract with CMS enterprise-wide.

 
Job Responsibilities:

• Thoroughly Investigate, resolve, and clearly document all CTM issues with priority to urgent and immediate need CMS requests, special cases and management requests from start to finish within the required timeframe.
• Follow departmental policies and procedures and federal regulatory requirements when making decisions on member impact, compliance, and other implications.
• Assist with new hire onboarding and training activity.
• Back up to other team members who are out of the office or take on additional workload to ensure timely case closure.
• Conduct peer-to-peer quality reviews, identify gaps and deficiencies, provide feedback and opportunities for improvement.
• Identify system issues causing increased complaints and suggest improvements to prevent future occurrences.
• Provide recommendations and collaborate with leaders and business partners in operating efficiencies.
• Facilitate meetings with cross-functional business partners, as necessary, to properly address complex cases.
• Provide expertise in triaging escalated sensitive/high risk issues from receipt to resolution.
• Participate in weekend coverage rotation.

 
Knowledge, Skills, Abilities Required:

• Extensive knowledge of CTM team processes and Medicare MAPD and PDP guidelines.
• Ability to work a flexible work schedule that may include Saturday as a normal workday or a holiday weekend on a rotating basis.
• Excellent verbal and written communication skills, as well as, listening and conflict resolution skills.

 
Required Job Qualifications:

• Bachelor’s degree preferred or 4+ years of experience in Medicare Advantage and PDP plans.
• Knowledge in Medicare regulatory requirements.
• Proficiency in CMS systems preferred and Microsoft Office (Excel, Word, Outlook).

 
Preferred Job Qualifications:
Bilingual preferred (Spanish)