Medicare Retention Manager

Job Description

Job Description

POSITION SUMMARY

The Medicare Retention Manager position is responsible for Medicare Advantage members to address concerns that may lead to voluntary disenrollment. This role emphasizes member education, satisfaction, and long-term plan retention while maintaining strict adherence to CMS guidelines. The Specialist will collaborate with multiple departments to identify systemic issues contributing to member dissatisfaction and promote solutions that enhance the member experience and reduce turnover.

This position works fully onsite Monday- Friday. 

ESSENTIAL DUTIES & RESPONSIBILITIES

1. To perform this job, an individual must perform each essential function satisfactorily, with or without reasonable accommodation; including, but not limited to:
2. Serve as a liaison between the plan, members, and various departments to effectively identify and resolve disenrollment issues.
3. Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication. 
4. Proactively engage at-risk members to educate them on plan benefits, resolve concerns, and encourage continued enrollment.
5. Educate members about plan benefits and available resources  
6. Document interactions in compliance with CMS regulations  
7. Resolve member issues or escalate as needed  
8. Maintain knowledge of current CMS rules and updates

QUALIFICATIONS & EDUCATION

1. High school diploma / GED (or higher) OR 5+ years of equivalent working experience. 
2. 1-2 Years of experience in Healthcare Customer Service Role
3. Knowledge of Medicare Advantage Plans is a plus
4. Excellent verbal and written communication skills
5. Commitment to excellence and high standards  
6. Strong organizational, customer service, problem-solving, and analytical skills
7. Able to manage priorities and workflow.  
8. Demonstrates a high level of professionalism in dealing with confidential and sensitive issues. 
9. Ability to work effectively, independently and in a team environment.
10. Ability to deal effectively with a variety of individuals. 
11. Fluency in Spanish and English preferred.
12. Proficiency in computer software (i.e. Microsoft Word, Excel, Power-Point, and Outlook) and the ability to learn new and complex computer system applications (including comfort using short-cut keys/demands). 

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

1. The noise level in the work environment is usually moderate. 
2. Interacts with health plan members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances. 
3. 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. 
4. The work is performed indoors.   
5. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. 
6. The work schedule is approximate, and hours/days may change based on company needs.  

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.

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.