Member Engagement Representative Medicare

We are seeking an experienced Member Engagement Representative to support Medicare Advantage members through exceptional customer service, member retention, and plan education. This position is responsible for assisting Medicare beneficiaries with plan information, benefits, network and pharmacy inquiries, and plan changes while ensuring strict compliance with applicable Medicare regulations.

The ideal candidate will have experience working with Medicare beneficiaries, a strong understanding of health insurance and Medicare compliance requirements, and the ability to deliver accurate, personalized service in a fast-paced environment.

Key Responsibilities

• Provide exceptional, personalized service to Medicare members by phone and in person.
• Assist members with questions regarding plan information, benefits, provider networks, pharmacies, and plan changes.
• Complete Medicare Advantage plan change requests over the phone using approved, compliant scripts.
• Document all member interactions accurately and maintain appropriate records and reporting systems.
• Track and follow up with members who may be at risk of disenrollment.
• Make outbound calls to members regarding plan, benefit, network, or other important changes during the Annual Enrollment Period (AEP).
• Educate Medicare beneficiaries about available plan options and assist them in selecting the most appropriate plan based on their needs.
• Support member retention and outreach programs.
• Assist with administrative activities related to tracking and monitoring plan change requests.
• Provide support during in-person presentations or member engagement activities, as needed.
• Maintain compliance with applicable federal and state regulations, Medicare requirements, and marketing guidelines.
• Follow all organizational policies, procedures, and compliance standards.
• Complete required product and plan training successfully.
• Perform additional administrative and member engagement duties as assigned.

Required Qualifications

• High School Diploma or GED required.
• Associate’s degree or Bachelor’s degree preferred.
• Minimum of 2 years of experience in a call center, customer service, or support role within the health insurance industry.
• Experience working directly with Medicare beneficiaries is required.
• Strong understanding of Medicare, health insurance compliance, plan design, and benefits.
• Working knowledge of Medicare Advantage plans and applicable compliance requirements.
• Excellent customer service and phone communication skills.
• Ability to communicate complex plan information clearly and accurately.
• Strong listening, critical thinking, problem-solving, and organizational skills.
• Ability to multitask while navigating multiple computer applications and systems.
• Ability to work independently while also collaborating effectively within a team environment.
• Strong attention to detail and ability to manage frequent interruptions and competing priorities.

Preferred Qualifications

• Active Health Insurance License preferred but not required.
• Candidates with an active Health Insurance License may be eligible for a higher bill rate.
• Previous experience with Medicare Advantage plans, member retention, or enrollment support strongly preferred.
• Experience with CRM, member documentation, database, and reporting systems is a plus.

Additional Information

• 100% onsite position
• Monday–Friday schedule
• No weekends
• Candidates must be available to interview via Microsoft Teams.
• Please provide candidate interview availability, including specific dates and times, with the submission.
• Successful candidates must be willing and able to commute to the work location five days per week.
• Multiple openings are available.

If you have the required health insurance, Medicare, customer service, and member engagement experience and are comfortable working in a fully onsite environment, we encourage you to apply!

 At Encode, we believe that our employees are our greatest asset, and we are committed to fostering a supportive and inclusive work environment. We offer a comprehensive benefits package that includes health insurance, retirement plans, and generous paid time off. Our flexible work arrangements and emphasis on work-life balance ensure that our employees can achieve their professional goals while maintaining a healthy personal life. Additionally, we provide opportunities for continuous learning and career advancement, including professional development programs and access to cutting-edge technologies.

As a cleared facility, we have a particular need for individuals with active Secret or Top Secret clearances. Your expertise and security clearance would be invaluable in supporting our mission-critical projects and ensuring the highest standards of security and compliance.

We would love to discuss how your experience and skills align with our needs and explore potential opportunities with Encode. If you are interested in learning more, please reply to this email with your updated resume and a convenient time for a brief conversation.

Thank you for considering this opportunity. We look forward to the possibility of working together and contributing to your professional journey.