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Medicare Inbound Jobs in California (NOW HIRING)

WelbeHealth

Senior Care Advisor

Los Angeles, CA · On-site

$147K - $147K/yr

Other tasks will include answering inbound and doing follow-up calls, as well as outbound calls to ... Medicare Advantage or PACE experience preferred * Medi-Cal knowledge preferred Benefits of Working ...

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Medicare Inbound information

What is a Medicare Inbound representative?

Medicare Inbound representatives are customer service professionals who handle incoming calls from individuals seeking information about Medicare plans, enrollment, and benefits. They assist callers—often seniors or those approaching eligibility—with understanding plan options, coverage details, and the enrollment process. Their role is crucial in providing accurate, clear information to help people make informed healthcare decisions. These representatives often work for insurance companies or third-party agencies that support Medicare beneficiaries.

What skills and qualifications are needed to thrive as a Medicare Inbound representative?

To excel as a Medicare Inbound Representative, you typically need strong knowledge of Medicare plans, excellent customer service skills, and a high school diploma or equivalent. Familiarity with CRM systems, call center software, and sometimes a health insurance license are important technical qualifications. Outstanding communication, patience, and problem-solving abilities help representatives build trust and effectively address client needs. These competencies ensure accurate information delivery, regulatory compliance, and a positive customer experience for Medicare beneficiaries.

What is the difference between Medicare Inbound vs Medicare Customer Service Representative?

AspectMedicare InboundMedicare Customer Service Representative
CertificationsKnowledge of Medicare policies, possibly required certificationsSame certifications, focus on Medicare knowledge
Work EnvironmentCall centers, remote or office-basedCall centers, remote or office-based
Employer & IndustryHealth insurance companies, Medicare providersHealth insurance companies, Medicare providers
Job FocusHandling inbound calls about Medicare plans and coverageAssisting customers with Medicare inquiries and issues

Both roles involve assisting Medicare beneficiaries via inbound calls, requiring similar certifications and work environments. The main difference lies in job titles used by employers, but their responsibilities and industry context are closely aligned.

What are common challenges faced by Medicare Inbound representatives, and how can they be managed?

Medicare Inbound representatives often encounter challenges such as handling high call volumes, addressing complex customer inquiries about benefits and coverage, and staying current with frequently changing Medicare regulations. To manage these challenges, it's important to develop strong organizational skills, utilize internal resources and knowledge bases, and actively participate in ongoing training. Effective communication and patience are also key, as representatives regularly interact with seniors who may need extra assistance understanding their options.
What are popular job titles related to Medicare Inbound jobs in California? For Medicare Inbound jobs in California, the most frequently searched job titles are:
What job categories do people searching Medicare Inbound jobs in California look for? The top searched job categories for Medicare Inbound jobs in California are:
What cities in California are hiring for Medicare Inbound jobs? Cities in California with the most Medicare Inbound job openings:
Medicare Inbound jobs near you
Infographic showing various Medicare Inbound job openings in California as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

MEDICARE SPECIALIST (Medicare Billing)

Stance Health Solutions

CA • On-site, Remote

$23.67 - $29.77/hr

Full-time

Re-posted 8 days ago

Job description

Job Type
Full-time
Description
Position Overview
This position collaborates with global and domestic cross-functional teams (order to cash), including Intake, Customer Care, and Billing, to resolve patient questions, concerns, and issues related to Medicare coverage, claims, denials, and patient responsibility. Responsibilities include inbound and outbound calls, insurance verification & payer change, invoice review, appeals and denial resolution, payment processing, and interpretation of claims and EOBs, all within a compliant, audit-ready framework.
This position operates in a call queue environment and serves as the primary point of contact for inbound patient billing inquiries within the Revenue Cycle Management (RCM) team, with a strong focus on Medicare-related billing, eligibility, and claims resolution. The role is responsible for delivering a high level of patient support while ensuring compliance with Medicare guidelines, CMS requirements, and DMEPOS billing standards.
Key Responsibilities
  • Handle high-volume inbound and outbound calls related to Medicare billing statements, coverage, payment plans, and coordination of benefits (COB)
  • Accurately document all patient interactions, including inquiries, complaints, and resolutions, ensuring compliance with Medicare and internal documentation standards
  • Interpret EOBs and explain Medicare patient responsibility, coverage limitations, and claim outcomes
  • Verify insurance eligibility, benefits, and coverage through payer portals, with a focus on Medicare qualification and active coverage
  • Review and recalculate invoices as needed to ensure alignment with Medicare billing rules and reimbursement guidelines
  • Manage and resolve denials and appeals, ensuring proper documentation and adherence to Medicare requirements for medical necessity and claims processing including Medicare audits.
  • Request and validate clinical documentation, prescriptions, and supporting records required to meet Medicare medical necessity standards
  • Identify and document compliance or non-compliance with treatment requirements, as applicable to Medicare coverage criteria
  • Coordinate with internal teams to ensure claims are clean, accurate, and ready for submission or resubmission
  • Respond to patient communications across multiple channels, including phone, email, portal, and fax
  • Route complex issues to appropriate teams while maintaining ownership of resolution
  • Ensure adherence to HIPAA, confidentiality, and Medicare compliance requirements at all times
  • Follow up on open tasks, worklists, and outstanding issues in a timely manner
  • Support equipment recovery processes when treatment ends or Medicare benefits terminate
  • Maintain knowledge of Medicare billing, reimbursement guidelines, and DMEPOS requirements
  • Identify trends and escalate training or process improvement opportunities
  • Perform other duties and special projects as assigned
  • Developing standard operating procedures for Medicare Order-to Cash.

Qualifications
  • Minimum of 2 years of customer service experience, preferably in a role emphasizing ownership of the customer or patient financial experience
  • Minimum of 2 year of experience in healthcare, with extensive expertise to Medicare billing, RCM, or DMEPOS environments preferred
  • Understanding of healthcare terminology, with working knowledge of Medicare claims, EOBs, and patient responsibility
  • Strong customer service, problem-solving, and critical thinking skills, with the ability to navigate Medicare-related billing and coverage questions
  • Ability to manage high-volume inbound calls and communications while maintaining accuracy and compliance
  • Strong verbal and written communication skills, with the ability to explain Medicare billing, coverage, and denials in a clear and professional manner
  • High attention to detail, with the ability to identify and correct errors related to claims, documentation, and billing accuracy
  • Ability to multitask, prioritize, and follow through in a fast-paced, metrics-driven environment
  • Self-starter with the ability to work independently and collaboratively across teams
  • Flexible and adaptable to changing business needs, particularly in a growing Medicare-focused operation
  • Proficiency in billing systems and Microsoft Office 365; experience with Brightree or similar DME billing platforms preferred

Salary Description
$23.67 to $29.77

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