About the position
The Customer Service Professional (CSP) acts as the primary MGB Health Plan 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 inquiries. 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.
Responsibilities
- Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquiries such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures.
- 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.
- Initiate 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 MGB 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 including Communication, Flexibility/Adaptability/Willingness/Team Player/Positive Attitude, Relationship Building/Caring, Service Excellence/Accountability/Critical Thinking.
Requirements
- High School Diploma or equivalent.
- 4+ years in customer service environment.
- Knowledge of customer service principles and practices.
- Ability to resolve customers' problems and to demonstrate patience and remain courteous when faced with difficult or angry callers.
- Ability to work well under pressure and in a rapidly changing environment.
Nice-to-haves
- Associates Degree or Bachelor's Degree.
- High school and college level courses in computers, English, or business helpful.
- Bilingual (Spanish) or other.
- 2+ years in an HMO/Health Care Industry setting.
- Knowledge of call center telephony and technology.
- Proficiency with MS Office suite.
- Understanding of Protected Health Information (PHI) and the necessity to maintain confidentiality of this information.
- Understanding of or training in Medical terminology.
- Understanding of medical coding is helpful.
