Member Services Representative - Full-time

• 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.

Qualifications:

• 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