Customer Service Representative

Mass General Brigham

2d•$19 - $28•Remote

About The Position

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 Customer Service Rep 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.

Requirements

High School Diploma or Equivalent required
Exceptional Customer Service skills, both verbal and written communication must be concise, clear, compliant, personable and professional
Ability to multi task and prioritize
Maintain Customer Service Behavior Competencies
Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
Relationship Building/Caring
Service Excellence/Accountability/Critical Thinking
a quiet, secure, stable, and compliant work station is required from within the US, with MGB provided equipment and Video required during the work week

Nice To Haves

Associate's Degree in related field or Healthcare Management preferred
Call Center experience a plus

Responsibilities

Serves 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
Handles 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
Acts 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.