Recruiter's Glossary

Examples: Member Services • PPO • Underwriting

Medicare

Term from Health Insurance industry explained for recruiters

Medicare is the federal health insurance program in the United States primarily for people aged 65 and older. When this term appears in job descriptions or resumes, it usually refers to experience working with Medicare insurance plans, claims, or regulations. Medicare has different parts (Part A, B, C, and D) that cover various healthcare services. Insurance companies and healthcare organizations often look for professionals who understand how Medicare works because it's a major part of the US healthcare system. Similar programs include Medicaid (for low-income individuals) and private insurance plans.

Examples in Resumes

Processed Medicare claims and appeals for a major healthcare provider

Explained Medicare coverage options to 50+ seniors daily

Managed team handling Medicare enrollment periods and plan transitions

Achieved 98% accuracy rate in Medicare billing and coding

Typical job title: "Medicare Specialists"

Also try searching for:

Medicare Coordinator Medicare Billing Specialist Medicare Claims Processor Medicare Enrollment Specialist Medicare Customer Service Representative Medicare Benefits Coordinator Medicare Sales Agent

Where to Find Medicare Specialists

Professional Organizations

Job Boards

Professional Networks

Example Interview Questions

Senior Level Questions

Q: How would you handle a complex Medicare appeal case?

Expected Answer: A senior specialist should explain the multiple levels of appeals, demonstrate knowledge of appeal timeframes, documentation requirements, and ability to handle challenging cases while maintaining compliance with CMS regulations.

Q: How do you stay current with Medicare policy changes?

Expected Answer: Should discuss regular monitoring of CMS updates, attendance at industry conferences, participation in professional organizations, and experience implementing policy changes across teams.

Mid Level Questions

Q: Explain the difference between Medicare Advantage and Original Medicare.

Expected Answer: Should clearly explain that Original Medicare is government-provided coverage (Parts A and B), while Medicare Advantage (Part C) is offered by private insurance companies and often includes additional benefits.

Q: How do you explain Medicare Part D coverage gap to beneficiaries?

Expected Answer: Should demonstrate ability to explain complex concepts in simple terms, including how the coverage gap works, when it applies, and strategies to help beneficiaries manage medication costs.

Junior Level Questions

Q: What are the four parts of Medicare?

Expected Answer: Should be able to explain Part A (hospital), Part B (medical), Part C (Medicare Advantage), and Part D (prescription drugs) in simple terms.

Q: When are the Medicare enrollment periods?

Expected Answer: Should know Initial Enrollment Period (around 65th birthday), Annual Enrollment Period (Oct 15-Dec 7), and Special Enrollment Periods.