Remote Healthcare Customer Service Specialist – Medicare Member Outreach & Utilization Support at careerzynith

Join careerzynith: Make a Meaningful Impact in Healthcare from Anywhere

Are you passionate about helping others navigate the complexities of healthcare while enjoying the flexibility of a fully remote career? careerzynith is searching for a dedicated and compassionate Remote Healthcare Customer Service Specialist to join our growing team. In this role, you will play a vital part in supporting Medicare members through proactive outreach, care coordination, and utilization review activities. If you thrive in a fast-paced, member-focused environment and have a background in managed care, medical administration, or healthcare customer service, this is your opportunity to make a real difference in the lives of members while building a rewarding career with careerzynith.

As a trusted partner in the healthcare industry, careerzynith is committed to delivering exceptional service to Medicare populations across the United States. Our mission centers on connecting members with the resources, information, and support they need to live healthier lives. We believe that every phone call is an opportunity to provide clarity, comfort, and care—and we are looking for talented professionals who share that vision.

About the Role

The Remote Healthcare Customer Service Specialist at careerzynith is responsible for conducting high-volume outbound calls to Medicare members, assisting with medical and psychological utilization and coordinated care activities, and maintaining meticulous documentation throughout the process. This is a contract position with an initial duration of three months, with strong potential for extension or conversion based on performance and business needs.

This position is ideal for someone who is highly organized, self-motivated, and excels in a remote work environment. You will be expected to manage your time effectively, maintain a dedicated home office setup, and consistently meet performance metrics that reflect your commitment to quality and compliance.

Key Responsibilities

• Member Outreach: Conduct a high volume of outbound telephone calls daily (80–120 calls per day) to Medicare members assigned to your caseload, providing support related to utilization review, care coordination, and general healthcare inquiries.
• Documentation Excellence: Accurately document every member interaction in the Virtual Health system, ensuring all notes are thorough, timely, and compliant with HIPAA regulations and careerzynith standards.
• Spreadsheet Management: Consistently update and maintain an Excel spreadsheet tracking member assignments, outreach attempts, and engagement outcomes to support data-driven decision-making and reporting.
• Utilization & Care Coordination Support: Assist in activities related to the medical and psychological aspects of utilization management and coordinated care, helping members understand their benefits, treatment plans, and next steps.
• Supervisor Communication: Maintain open and consistent communication with your direct supervisor, providing regular updates on progress, challenges, and member feedback.
• Compliance Adherence: Ensure 100% compliance with all assigned member outreach requirements and maintain an engagement rate of 80% or higher monthly.
• Productivity Targets: Successfully complete outreach to approximately 600 members per month, with a daily goal of 30 new member assignments.
• Audit Readiness: Maintain a minimum audit score of 90% by adhering to documentation standards, call quality protocols, and regulatory guidelines.

Essential Qualifications & Skills

• Experience: 2–3 years of experience in a managed care setting, medical office, or healthcare facility with demonstrated medical administration duties.
• Industry Knowledge: Thorough understanding of customer service, utilization review, and claims processing practices within a managed care environment.
• Technical Proficiency: Strong working knowledge of Microsoft Office Suite, with advanced Excel skills including data entry, formula usage, and spreadsheet management.
• Medical Terminology: Solid grasp of medical terminology to effectively communicate with members and healthcare providers.
• Communication Skills: Exceptional verbal and written communication skills, with the ability to explain complex healthcare information in a clear, empathetic, and member-friendly manner.
• Time Management & Organization: Proven ability to manage multiple priorities, meet daily and monthly targets, and stay organized in a remote work environment.
• Home Office Requirements: Reliable high-speed home internet with a hardwired connection (required for HIPAA compliance), plus a dedicated, distraction-free workspace.
• Education: High school diploma or equivalent required.

Preferred Qualifications

• Prior experience working directly with Medicare populations or in a utilization management role.
• Familiarity with Virtual Health or similar electronic health record/documentation platforms.
• Bilingual abilities (Spanish/English) are a plus but not required.
• Experience working remotely in a healthcare or contact center setting.

Performance Expectations at careerzynith

At careerzynith, we hold ourselves to the highest standards of service, compliance, and member care. To succeed in this role, you must be comfortable making a high volume of outbound calls each day, maintaining accurate documentation, and consistently meeting engagement and compliance targets. Time off is not permitted during the first 90 days of employment unless pre-approved and scheduled during the interview process. This ensures continuity of care for our members and a strong foundation for your success at careerzynith.

Work Schedule & Location

• Location: Fully remote — must reside in the United States.
• Work Hours: 8:30 AM – 5:30 PM Eastern Standard Time (EST), Monday through Friday.
• Compensation: $20.00/hour.
• Contract Duration: 3 months with potential to extend or convert to a permanent role based on performance.

Why Join careerzynith?

When you join careerzynith, you become part of a mission-driven organization that values empathy, accountability, and excellence. We offer:

• Meaningful Work: Every call you make has the potential to improve a member's health journey and connect them with critical resources.
• Career Growth: careerzynith invests in its team members with opportunities for professional development, cross-training, and advancement into roles such as Team Lead, Quality Auditor, or Utilization Review Specialist.
• Supportive Culture: We foster a collaborative, inclusive remote work environment where your contributions are recognized and your well-being matters.
• Flexibility: Enjoy the benefits of working from home while building a rewarding career in healthcare.
• Comprehensive Training: Receive thorough onboarding and ongoing support to help you succeed in your role and grow within the organization.

Benefits & Perks

While specific benefits may vary based on contract length and eligibility, careerzynith team members typically enjoy:

• Competitive hourly compensation with potential for performance-based incentives.
• Remote work flexibility with a supportive virtual team environment.
• Paid training and professional development opportunities.
• Access to healthcare benefits for eligible employees.
• A culture that prioritizes work-life balance and member-centric service.

How to Apply

If you're ready to bring your healthcare expertise, customer service skills, and passion for helping others to careerzynith, we encourage you to apply today. This is your chance to join a team that truly values the impact of every interaction and is committed to supporting your professional growth. Don’t miss this opportunity to build a fulfilling career in healthcare from the comfort of your home office.

Apply now and become part of the careerzynith mission to deliver compassionate, compliant, and high-quality care to Medicare members nationwide.