Member Services Representative
We have a full-time opening for a Member Services Representative.
Must be able to work various shifts per week.
- Minimum Age
- 21+ years old
- Respond to, and answer all member and provider inquiries in a courteous, responsive, comprehensive, effective, and accurate manner following all departmental and organizational policies and procedures.
- Participate as part of a team conducting and/or supporting outreach to members regarding benefits and eligibility requirements.
- Thoroughly document all member related and prospective member interactions into internal database for purpose of accurate tracking and analysis.
- Coordinate with various roles internally and its interdisciplinary and/or primary care partners to ensure external and internal customer requests and questions are handled appropriately and in a timely manner.
- Access and understand all related education resource material in order to respond to a member's questions and concerns accurately and appropriately.
- Provide direct member education about benefits in an ongoing, proactive manner.
- Process members' grievances and appeals in accordance with companies policies.
- Process members' disenrollment in accordance with companies policies.
- Use computerized systems for tracking, information gathering, and troubleshooting.
- Offer recommendations for improvements in Call Center and procedures to enhance service delivery and customer satisfaction.
- Provide translation and interpretation when requested/approved by supervisor.
- Take responsibility for one or more administrative functions or special projects of the Member Services Department.
- Daily tasks include: ongoing incoming and outgoing phone calls; ongoing incoming and outgoing email; ongoing use of member database and members' electronic medical records; processing paper mail; and processing faxes.
- Provide other duties as assigned.
- Knowledge of Massachusetts' health care delivery system/services;
- Prior experience working in medical setting;
- Prior experience working in a Call Center;
- Ability to complete mail merge;
- Experience using and entering data into electronic medical records.
- Must have experience working in a diverse environment: colleagues, members and providers are diverse socioeconomically, ethnically, and culturally.
- Must possess exceptional oral and written communication skills, including the ability to manage difficult callers and conflict.
- Must be flexible and comfortable working in an environment that includes continual change for quality improvement.
- Must have the ability to: develop a thorough knowledge of benefits, related payment policies, and medical terminology; work independently as well as within a team environment; prioritize work; and manage and track outstanding work and work due in the future.
- Bachelors or Associates Degree required
- Call Center experience
- Healthcare or Medical setting experience
- Highly preferred Bilingual in either Spanish, Portuguese, Russian, Vietnamese, Haitian Creole, French Creole or Portuguese Creole
Start Date: February 13th