Job Description
Member Services Representative
Location Boston, Massachusetts, 02108 Category Call Center Job Id 23-474 Job Type Regular Fulltime Boston, MA Non-Exempt Department 011520 – CCA-Call Center
Why This Role is Important to Us:
The Member Services Department provides a single point of contact for questions, problem solving, and access to care, for members of the Senior Care Options (SCO) and One Care Programs and all those involved in CCA members’ care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all constituents; including enrolled and prospective members, providers, Commonwealth Care Alliance internal workforce, and employees of state and federal agencies. The MSR serves as a facilitator for member inquiries and assistswith accessing care. This position focuses on educating members on health plan benefits, products, and services, and will triage calls to the appropriate destination. The MSR will also report to and receive daily instruction from a Contact Center Supervisor. After training, the MSR will be expected to have a solid understanding of operational, telecom, and IT related systems specific to Contact Centers in the health care industry. This position is remote and may offer some scheduling flexibility. The Ideal candidate: We are looking for a tenacious yet personable and compassionate individual who is able to solve complex problems while delivering outstanding customer service to our members. If you are reliable, kind, and thrive in a challenging work environment, you could be a great addition to our team.
What You’ll Be Doing:
Key Responsibilities
Respond and effectively triage member phone calls to accurately and timely route to appropriate area
Work with care management team to address the needs of members, caregivers and other CCA constituents
Provide timely and accurate information regarding member benefits and services including Continuity of Care
Meticulously document all member and prospective member interactions in a Centralized Electronic System
Responsible for the scheduling of member appointments, transportation, translation, and interpretation services
Initiates Prior Authorization Intake process
Attends to erroneous member billing discrepancies
Assist with member mailings and respond to questions about mailings
Responsible for providing members with any requested documents including provider listings in their areas
Complete comprehensive appeal and grievance intakes.
Assist with timely resolution of quandaries or complaints conveyed by member and members’ representative
Responsible for conducting in dept. research to provide accurate and informed resolution to members inquiries
Assist in the collection of supporting data and documentation relevant to member’s care
Serve as a facilitator connecting members to their CCA providers thru Telemedicine accessibility
Responsible for educating members on benefits and services available as well as protocols and requirements
Responsible for acting in compliance with HIPAA, State and Federal regulations when assisting CCA members
Responsible for meeting departmental expectations, benchmarks, goals, and key performance indicators
Other responsibilities and duties as assigned
Expectations of all Employees
Demonstrate integrity by working with passion, commitment, and honesty, acting in the best interests of colleagues and members. Demonstrate accountability by delivering on commitments and contributing to an empowering environment where the focus is on member satisfaction by providing best in class service.
Recognize and respect diversity in all forms. Strive for excellence in the fulfillment of CCA’s mission through quality, innovation, and continuous learning. Represent CCA and its clinical affiliates with professionalism. Keep current and proficient with necessary skills and knowledge including technology.
Adhere to all applicable compliance requirements such as CCA’s Policy & Procedures. Ensure confidentiality of member and company proprietary information is maintained
What We’re Looking For:
Minimum Education Required: Associates Degree or Post High School Training/ Certification/ Education Required.
Preferred Educational Experience: An Associate or bachelor’s degree in any general or health-oriented fields is preferred.
Also, experience in health care, the non-profit service sector, or government is preferred. Technical accreditation in the health care field (i.e., Medical Assistant | Billing and Coding) is a plus.
Minimum Years’ Experience Required: 1-3 years
Minimum Experience: Not less than one-year customer service experience.
Knowledge, Skills and Abilities: Experience and competent in working with a diverse disabled and elderly population
Schedule Requirements: The ability to complete a four-week hybrid training that includes training in our Boston office. The ability to work nights/weekends.
Must be passionate about serving others and able to show empathy to distress individuals
Must have experience providing customer-focused service and activities
Experience working independently while in a team environment.
Skilled in problem solving by referencing departmental standard operating procedures and workflows.
Critical thinking and sound judgement
Prior experience working in the health care industry front lines or medical setting preferred
Prior experience working in a Call/Contact Center preferred
Must be resilient and adaptable working in an environment that includes continuous change
Experience working in a quality-focused environment with a rigorous quality assurance measuring program
Proven proficiency working in a metrics, benchmarks and goals driven in an active work environment.
Reliability and punctuality are a must
Computer literacy a must, demonstrated ability to work with multiple complex systems simultaneously
Ability to document information clearly and efficiently using medical terminology a must
Excellent interpersonal skills required and ability to interact professionally
Experience working in a diverse environment: socioeconomically, ethnically, and culturally
Capacity to kindly and respectfully assist all our constituents including irate and difficult callers, with the uppermost level of customer service.
Preferred Previous Work Experience: Currently or recently employed in customer service, public service, as front-line health care worker, or in a contact center.
Equipment Utilized: Standard Office Equipment – Remote Connectivity Equipment
Language Requirements: Superb verbal and written communications skills in English required
Articulate and adept in medical terminology preferred
Test proven proficiency in at least one other language strongly preferred
Physical Requirements: Ability to sit for long periods of time – Light lifting and bending
Working Conditions: The MSR position requires the ability to sit at a desk in a call center or home office, while talking on the telephone and using the computer, for eight hours each day.
Commonwealth Care Alliance is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, status as a protected veteran, or any other category protected by applicable federal, state or local laws.