Member Services Specialist (4pm to 8pm EST)

 

Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 34 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.

Summary

The role involves responding to member and provider inquiries related to Medicare benefits, eligibility, claims, and enrollment through phone and written communication. Responsibilities include analyzing and resolving issues, documenting outcomes, maintaining accurate records in internal systems, and ensuring timely follow-up. The position also supports positive member and provider relations, collaborates across departments to address service issues, and contributes to contact center documentation. 

Essential Duties & Responsibilities

• Responds to Member/Provider questions via telephone and written correspondence regarding Medicare benefits, enrollment questions, change requests, eligibility, and claims.
• Analyzes problems and provides information/solutions.
• Utilizes internal systems to obtain and extract information, documents information, activities, and changes in the database.
• Thoroughly documents inquiry outcomes for accurate tracking and analysis.
• Develops and maintains positive member/provider relations and coordinates with various functions within the company to ensure requests and questions are handled appropriately and in a timely manner.
• Researches and analyzes data to address operational challenges and member/provider service issues.
• Requires knowledge of health insurance benefits.
• Seeks, understands, and responds to the needs and expectations of internal and external customers.
• Create and manage documentation specific to contact center
• Other duties as assigned.

Qualifications

• H.S. graduate or GED;
• Heath insurance experience required.
• Medicare experience preferred. Medicare Advantage plans experience is a bonus.
• Customer service and Call center experience preferred.
• Proficient written and oral communication skills required.
• Compliance, at all times, with CMS regulations regarding Medicare Advantage Plans
• Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team;
• Exceptional organizational skills
• Proficiency in computer skills including Microsoft Office Suite products

 

 

Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.

The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.

 

*The company is unable to provide sponsorship for a visa at this time (H1B or otherwise).