Operations Team Lead

About the work - Member Services for Seniors:

Segments we will support (Phase 1)

• Medicare Advantage (Part C)

  : End-to-end plans covering hospitalization, medical services, and prescriptions.

• Group Retiree Plans

  : Tailored benefits for retired employees of corporations, government, or unions, often with layered entitlements and detailed queries.

• D-SNP (Dual-Eligible)

  : For members eligible for both Medicare and Medicaid. These are low-income or disabled seniors, requiring high sensitivity and multi-agency coordination.

Call types expected

• Plan eligibility, enrollment, and disenrollment
• Co-pay and deductible clarifications
• Benefit explanations (vision, dental, OTC)
• Provider and PCP changes
• Claims, EOBs, and billing support
• Pharmacy exceptions and drug tier clarifications
• Appeals, grievances, and service denials
• Hospice and long-term care coordination
• Medicaid coordination

Skill requirements

• Deep understanding of CMS (Centers for Medicare & Medicaid Services) guidelines
• Familiarity with Medicaid programs by state
• Strong listening and verbal communication
• Patience and empathy for cognitive or hearing impairments
• Proficiency in navigating multiple systems and tools