Medicaid/Medicare Customer Service Representative
N/A, OFFSITE
Experience: 0
Category: Customer Service
Contractor Work Model: Remote
Brand: ALTA IT Services
Shift: On-Site
Job ID: 344458
Date Posted: 12/23/2025
Shortcut: http://jobs.systemone.com/FEFMOT
Job Title: Medicaid/Medicare Customer Service Representative (CSR)
Type: 3-month Contract
Compensation: $21/HR
Contractor Work Model: Remote
Purpose
The Medicaid/Medicare Customer Service Representative is responsible for responding to member, provider, and broker inquiries related to product information, benefits, claims resolution, eligibility, and billing in a call center environment. This role proactively provides education and guidance regarding health benefits, financial options, and self-service tools, while also offering basic technical support for digital and electronic applications.
Essential Functions
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Serve as the first point of contact for member, provider, and broker inquiries via telephone by gathering, reviewing, and researching information.
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Review and analyze claim submissions to ensure system accuracy, claim validity, and appropriate liability determination.
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Resolve issues in accordance with established policies and procedures while confirming customer understanding.
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Apply knowledge of healthcare products and contractual provisions to explain benefits, coverage limitations, and utilization guidelines in a clear and understandable manner.
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Administer services through telephonic, written, and electronic inquiries, including claims adjustments when applicable.
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Accurately document all customer interactions in accordance with departmental standards and compliance requirements.
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Deliver accurate, timely, and consistent information while meeting established performance and quality goals.
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Maintain and update customer records using enrollment systems, inquiry tracking tools, and business processes.
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Participate in ongoing training and professional development related to new services, regulatory updates, industry trends, and skill enhancement.
Required Skills & Qualifications
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High School Diploma or GED required.
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Less than one year of customer service experience required; call center or healthcare experience preferred.
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Clear verbal and written communication skills are essential for explaining complex Medicaid and Medicare benefits and resolving member concerns.
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Ability to simplify technical or industry-specific terminology, communicate with empathy, and maintain professionalism when interacting with diverse populations.
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Strong attention to detail and ability to follow policies, procedures, and regulatory guidelines.
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Basic technical proficiency with computer systems, including the ability to navigate multiple applications simultaneously and provide basic troubleshooting support.
Schedule & Training Requirements
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Contact center hours of operation are 8:00 a.m. – 8:00 p.m., seven (7) days per week.
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Training schedule is Monday through Friday, 8:30 a.m. – 5:00 p.m., and 100% attendance is required.
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Upon successful completion of training, associates will work 8-hour shifts, five (5) days per week, which may include weekends, based on business needs.
System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
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Ref: #850-Rockville (ALTA IT)
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Job Title: Medicaid/Medicare Customer Service Representative (CSR) Type: 3-month Contract Compensation: $21/HR Contractor Work Model: Remote Purpose The Medicaid/Medicare Customer Service Representative is responsible for responding to member, provider...
Date Posted: 12/23/2025 Recommended
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