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 in order 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
What We're Looking For:
Minimum Education and Experience Required:
Associate degree or equivalent experience.
Not less than one-year customer service experience.
Currently or recently employed in customer service, public service, as front-line health care worker, or in a contact center.
Experience and competent in working with a diverse disabled and elderly population
Must have experience providing customer-focused service and activities
Experience working independently while in a team environment.
Experience working in a quality-focused environment with a rigorous quality assurance measuring program
Experience working in a diverse environment: socioeconomically, ethnically, and culturally
Preferred Education and Experience:
A bachelor's degree in any general or health-oriented fields is preferred. Technical accreditation in the health care field (i.e., Medical Assistant | Billing and Coding) is a plus.
Experience in health care, the non-profit service sector, or government is preferred.
Prior experience working in the health care industry front lines or medical setting preferred
Prior experience working in a Call/Contact Center preferred
Knowledge, Skills & Abilities:
Must be passionate about serving others and able to show empathy to distress individuals
Skilled in problem solving by referencing departmental standard operating procedures and workflows.
Critical thinking and sound judgement
Must be resilient and adaptable working in an environment that includes continuous change
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
Capacity to kindly and respectfully assist all our constituents including irate and difficult callers, with the uppermost level of customer service.
Superb verbal and written communications skills in English required
Proficiency in at least one other language strongly preferred
Articulate and adept in medical terminology preferred
Equipment Utilized:
Standard Office Equipment
Remote Connectivity Equipment
Working Conditions:
The MSR position requires the ability to sit at a desk, while talking on the telephone and using the computer, for eight hours each day. The position requires the ability to focus on own work while sitting at a desk cubicle in a Call Center. The position also requires light lifting and bending, while filing member records and similar. The position might require occasional travel to contracted provider sites.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.