Site: Mass General Brigham Health Plan Holding Company, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

JOB SUMMARY

The Customer Service Professional (CSP) acts as the primary point of contact for our members, providers and other key stakeholders focusing on exceptional customer satisfaction and first call resolution.
The CSP’s interact with customers to provide information and troubleshoot complex issues in response to inquiries about coverage, benefits, services, and to handle and resolve complaints.
The person in this role must be committed to building customer confidence and increasing customer satisfaction by delivering to callers an exceptional experience focused on quality and accuracy.
The CSP’s will be initially trained on member demographic changes and benefit inquires. Additional member claims training will be delivered ±60 days after CSP has completed benefits and eligibility training.
After successfully demonstrating core competencies by meeting or exceeding key performance measurements, the individual will be trained to handle Provider claims inquiries as business needs dictate

QUALIFICATIONS

High School Diploma or Equivalent required or Associate’s Degree Healthcare Management preferred

• Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures.
• The CSP must be able to handle and demonstrate skills in handling benefits, claims and eligibility calls for the member and provider population.
• Identify customer issues/concerns rapidly and precisely
• Research required information using available resources and triage when necessary
• Handle and resolve customer inquiries and complaints, exhausting all efforts within the CSP’s scope before requesting assistance
• Identify and escalate priority issues in order to create efficiencies
• Initiates follow up customer calls where necessary
• Complete call logs to record customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken
• Refer customer grievances and appeals to designated departments for further investigation
• Responsible for navigating multiple systems in order to resolve customer issues
• Act as the primary representative for Mass General Brigham Health Plan for our customers focusing on first call resolution and customer engagement.
• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
• Maintain Customer Service Behavior Competencies
• Communication
• Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
• Relationship Building/Caring
• Service Excellence/Accountability/Critical Thinking