medicare insurance specialist

Solis Health Plans

<div><div><b>POSITION SUMMARY</b></div><div><br>
The Medicare Retention Specialist is responsible for supporting member retention efforts by providing exceptional customer service to Medicare Advantage members. This role focuses on addressing member concerns, resolving issues, and educating members on plan benefits to improve satisfaction and reduce voluntary disenrollment.</div><div>
This is an entry-level position ideal for candidates interested in healthcare, insurance, or customer service careers.</div><div></div><div><b><br>
Position is fully onsite. Schedule is Monday &ndash; Friday from 8:00 AM &ndash; 5:00 PM</b></div><div></div><div><b><br>
ESSENTIAL DUTIES AND RESPONSIBILITIES</b></div><div></div><div><br>
To perform this job, an individual must perform each essential function satisfactorily, with or without reasonable accommodation, including, but not limited to:</div><div></div><div><br>
<ul><li>
Respond to inbound and outbound calls from Medicare members regarding plan questions, concerns, and potential disenrollment requests</li><li>
Identify at-risk members and take proactive steps to improve retention</li><li>
Educate members on plan benefits, coverage, and available resources</li><li>
Resolve member issues related to claims, billing, pharmacy, and provider access</li><li>
Document all interactions accurately in the system in compliance with CMS guidelines</li><li>
Collaborate with internal departments (claims, enrollment, provider relations) to resolve escalated member issues</li><li>
Follow all compliance and regulatory requirements related to Medicare Advantage plans</li><li>
Meet performance metrics such as call quality, productivity, and retention goals</li></ul></div><div></div><div><b><br>
SUPERVISORY RESPONSIBILITY</b></div><ul><li>
None</li></ul><div></div><div><b><br>
QUALIFICATIONS AND EDUCATION</b></div><div></div><div><b><br>
Required Qualifications</b></div><div><ul><li>
High school diploma or equivalent required</li><li>
1-2 years of experience in customer service, call center, or healthcare environment required</li><li>
Bilingual (English/Spanish) required</li><li>
Strong verbal and written communication and problem-solving skills</li><li>
Basic computer proficiency (Microsoft Office, Excel, Outlook, CRM systems and ability to learn new systems quickly.</li><li>
Ability to handle sensitive situations with empathy and professionalism</li><li>
High level of professionalism and ability to handle confidential information</li></ul></div><div></div><div><b><br>
Preferred Qualifications</b></div><div><ul><li>
Experience working with Medicare or health insurance plans</li><li>
 Knowledge of CMS regulations (a plus, not required)</li><li>
 Prior experience in retention efforts</li></ul></div><div></div><div><b><br>
Core Competencies</b></div><div><ul><li>
Empathy and emotional intelligence</li><li>
Customer focus and service excellence</li><li>
Problem solving and critical thinking</li><li>
Communication skills (verbal and written)</li><li>
Team collaboration, works efficiently with internal depts.</li></ul></div><div></div><div><b><br>
WORKING CONDITIONS</b></div><p></p><p><br>
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.</p><div><ul><li>
The noise level in the work environment is usually moderate.</li><li>
Works in the field</li><li>
Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.</li></ul></div><p></p><div><br>
This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.</div><div></div><div><br>
The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.</div><div></div><div><b><br>
PHYSICAL DEMANDS</b></div><p></p><div><br>
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.</div><div></div><div><br>
The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.</div><div></div><div><b><br>
PERFORMANCE MEASUREMENTS</b></div><div><ul><li>
Duties accomplished at the end of the day/month.</li><li>
Attendance/punctuality.</li><li>
Compliance with Company regulations.</li><li>
Safety and Security.</li><li>
Quality of work.</li></ul></div><p></p><div><br>
This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.</div><div>
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple competing tasks and demands and to seek supervisory assistance as appropriate.</div><div></div><div><b><i><br>
Employee Acknowledgement:</i></b></div><p><b><i><br>
</i></b><br>
<b><i>I have read this job description and understand what is expected of me while I occupy this role.</i></b></p></div>

Medicare Retention Specialist

CVS Health

<div><p>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.</p><p></p><div><i>
- Rework team hours of operation are Monday through Friday from 6:00 AM - 7:30 PM Central Standard Time (CST)
</i><br>
<ul><li><i>Schedule flexibility including nights, weekend, and holiday coverage.</i></li><li><i>This is a full time work from home position</i></li></ul></div><p></p><p><b>
Position Summary</b></p><p></p><p>
Quality Specialist- Medicare D Quality role administers the quality management system to manage the review of clinical processes, documentation, and patient records.<br>
Interprets regulatory requirements from agencies and governing bodies to assist in the development of compliance policies and procedures.</p><p><br>
Additional Responsibilities to include but not limited to the following:<b><br>
</b></p><div><br>
<ul><li>Learning the rework queues for each line of business</li><li>Working rework reports timely</li><li>Researching and troubleshooting failed claims</li><li>Adding and/or editing overrides in RxClaim</li><li>Logging audits and errors accurately and timely</li><li>Ability to identify trends and provide suggestions for process improvement</li><li>Researching and correcting any issues found in the overall process.</li><li>Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed.</li><li>Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations.</li><li>Solving practical problems and dealing with multiple concrete variables in standardized situations.</li><li>Performing basic mathematical calculations.</li><li>Ensuring all cases are properly closed.</li><li>Ability to interpret a variety of work instructions provided through multiple mediums.</li><li>Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards.</li></ul><br>
<b>
Required Qualifications</b></div><div><ul><li><br>
2 years of Coverage Determination &amp; Appeals experience.</li><li>MHK, RxClaim, and People Safe proficient.</li><li>Meeting quality and productivity metrics in current role.</li></ul><br>
<b>
Preferred Qualifications</b></div><p></p><ul><li>3 years of Coverage Determination &amp; Appeals experience.</li><li>1 year of Medicare PART B experience</li><li>MHK, RxClaim, and People Safe proficient.</li><li>Meeting quality and productivity metrics in current role.</li></ul><p><b><br>
Education</b></p><p><br>
High School Diploma or equivalent GED</p><p></p><p><b>
Anticipated Weekly Hours</b></p>
40<p></p><p><b>
Time Type</b></p>
Full time<p></p><p><b>
Pay Range</b></p><p>
The typical pay range for this role is:</p><p></p>
$18.50 - $42.35<p></p><p>
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.</p><p><br>
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.</p><p></p><p><b>
Great benefits for great people</b></p><p></p><p>
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.</p><br>
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.<p><br>
Additional details about available benefits are provided during the application process and on Benefits Moments.</p><br>
We anticipate the application window for this opening will close on: 06/17/2026<p></p><p>
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</p></div>

Quality Specialist - Medicare D Quality

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Medicare Retention Specialist

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality

Quality Specialist - Medicare D Quality