Medicare Advantage Customer Service Professional (Pipeline)

Company: Brigham and Women's Hospital
Location: Somerville
Posted on: May 25, 2023

Job Description:

Job Description - Medicare Advantage Customer Service Professional (Pipeline) (3244029) Medicare Advantage Customer Service Professional (Pipeline) ( Job Number: 3244029 ) As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women's Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care, and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research. -

We're focused on a people-first culture for our system's patients and our professional family. That's why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees' personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development-and we recognize success at every step. -

Our employees use the Mass General Brigham values to govern decisions, actions, and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration. -The Customer Service Professional (CSP) acts as the primary Mass General Brigham 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 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.**Position is set to start in August/September**Primary Responsibilities:

• 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
• 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 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.
• Communication
• Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
• Relationship -Building/Caring
• Service Excellence/Accountability/Critical Thinking Qualifications - External Basic 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 environmentPreferred Qualifications:
    • Experience with Medicare Advantage
    • 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 EEO Statement Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.

Keywords: Brigham and Women's Hospital, Somerville , Medicare Advantage Customer Service Professional (Pipeline), Hospitality & Tourism , Somerville, Massachusetts