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FirstCarolinaCare Customer Service Representative - Medicare

Carle Health
United States, North Carolina, Pinehurst
June 26, 2022

Position Summary:

Interacts with customers to provide information in response to inquiries about products and services and to perform service recovery when appropriate. A strong focus is placed on member retention through relationship building and maintaining superior service standards.


Insurance Producer NC License within 6 months (Employer covers all costs of training and licensing.)

Three (3) years General - Customer Service

Strong verbal and written skills geared toward communicating with Medicare beneficiaries demonstrated by communicating by e-mail, phone, letters and in person. Able to project a positive image. Able to deal compassionately with Medicare beneficiaries on a one-on-one basis and focus on their needs through careful listening and patience. Able to perform at a constant pace while taking inbound calls and making outbound calls. Must be able to handle multiple tasks under constant pressure. Microsoft Office skills.

Essential Functions:

  • In compliance with Centers for Medicare and Medicaid Services, State Division of Insurance regulations and health plan guidelines, receives, researches, responds to and documents inquiries from or on behalf of members, prospective members and providers in a professional and courteous manner.
  • Takes action to resolve service, claims or billing escalations/complaints partnering with other departments if and when necessary. Follows-up to ensure that appropriate changes were made to resolve customer problem.
  • Qualifies and assigns leads generated by internal marketing efforts to contracted brokers or internal sales associates or induces sales independently.
  • Performs administrative tasks including but not limited to assembling mailings, distributing faxes, processing credit card transactions, and filing.
  • Conducts outbound call campaigns to existing members.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted. With an approved exemption, healthcare workers must do weekly testing and verify a negative COVID-19 test.

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