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

As a Medicare Member Service Rep, you will play a vital role in providing exceptional customer service and support to our Medicare Advantage plan members. Your primary responsibility will be to handle inbound calls from members, addressing their inquiries, resolving issues, and assisting with plan-related information. With your comprehensive knowledge of Medicare Advantage plans and excellent communication skills, you will ensure a positive experience for all callers while upholding regulatory compliance and meeting performance targets.

• Answer inbound calls for Medicare Advantage members to support line of business objectives, product, benefit administration, process improvement, efficiency, and above all, a first in class customer experience.
• Participate in member outreach campaigns as directed.
• Ability to work as a team player on cross-functional process improvement teams within the organization.
• This position will maintain, ensure, and foster an environment that enhances and promotes compliance, and conformance to all relevant federal, state, and local laws, rules, and regulations applicable to the company’s State and Federal contracts for MGBHP’s Medicare Advantage (MA) product offerings.
• Ability to cross-train on other products/Lines of Business.
• Acts as a member advocate to internal departments regarding issues, while understanding the underlying root cause and applicable regulatory requirements.
• Reads, interprets, and identifies necessary next steps related to complex member questions or issues.
• Provide accurate and detailed information regarding plan benefits, coverage, and eligibility criteria.
• Address and resolve inquiries, concerns, and issues raised by plan members, ensuring high customer satisfaction.
• Maintain a comprehensive understanding of Medicare Advantage plans, network providers, prescription drug coverage, and other related services.
• Document and update member records Mass General Brigham Health Plans call center database, ensuring accuracy and completeness of information.
• Collaborate with other team members, including supervisors, team leads, and other departments, to resolve complex member issues or escalate them appropriately.
• Meet or exceed performance metrics, including call quality, average handling time, first call resolution, and customer satisfaction scores.
• Continuously improve knowledge and stay updated with changes in Medicare Advantage plans, policies, and procedures through training programs and resources.
• Identify opportunities for process improvement and contribute to the development of best practices within the call center.

QUALIFICATIONS

• High School Diploma required, or equivalent work experience in healthcare, customer service, or related fields. Associate’s or Bachelor’s Degree preferred.
• Prior experience in customer service, preferably in the healthcare or insurance industry, Medicare or Medicare Advantage, are a plus.AHIP Certified or able to pass the AHIP certification within 90 days of training completion

• Answer inbound calls for Medicare Advantage members to support line of business objectives, product, benefit administration, process improvement, efficiency, and above all, a first in class customer experience.
• Participate in member outreach campaigns as directed.
• Ability to work as a team player on cross-functional process improvement teams within the organization.
• This position will maintain, ensure, and foster an environment that enhances and promotes compliance, and conformance to all relevant federal, state, and local laws, rules, and regulations applicable to the company’s State and Federal contracts for MGBHP’s Medicare Advantage (MA) product offerings.
• Ability to cross-train on other products/Lines of Business.
• Acts as a member advocate to internal departments regarding issues, while understanding the underlying root cause and applicable regulatory requirements.
• Reads, interprets, and identifies necessary next steps related to complex member questions or issues.
• Provide accurate and detailed information regarding plan benefits, coverage, and eligibility criteria.
• Address and resolve inquiries, concerns, and issues raised by plan members, ensuring high customer satisfaction.
• Maintain a comprehensive understanding of Medicare Advantage plans, network providers, prescription drug coverage, and other related services.
• Document and update member records Mass General Brigham Health Plans call center database, ensuring accuracy and completeness of information.
• Collaborate with other team members, including supervisors, team leads, and other departments, to resolve complex member issues or escalate them appropriately.
• Meet or exceed performance metrics, including call quality, average handling time, first call resolution, and customer satisfaction scores.
• Continuously improve knowledge and stay updated with changes in Medicare Advantage plans, policies, and procedures through training programs and resources.
• Identify opportunities for process improvement and contribute to the development of best practices within the call center