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 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.
- 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 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
- Communication
- Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
- RelationshipBuilding/Caring
- Service Excellence/Accountability/Critical Thinking
Department hours of operation:Monday, Tuesday, Wednesday, and Friday 8:00 am - 6:00 pm. Thursday; 8:00 am - 8:00 pm Shifts and Training Schedule:
- Training is required for the first four weeksuninterrupted. Shifts are 8:30 AM - 5:00 PM Mon - Fri EST. This is a virtual classroom setting.
- After training, employees will be scheduled for a working shift, new hires must be flexible between the following schedules:
- 9:00 AM - 5:30 PM (Mon, Tue, Wed, and Fri) with 11:30 AM - 8:00 PM (Thurs) (EST)
- 9:30 AM - 6:00 PM (Monday-Friday) (EST)
Qualifications
- 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
Workplace Policies
- All employees must be able to connect via ethernet cable to home router/modem to access web based secure programs to complete duties compliantly.
- Must have HIPAA-compliant workspace (a dedicated, private workspace with a lockable file cabinet that is free from distraction and separate from others, quiet and secure).
- COVID Vaccine initial series vaccine proof is required for all MGB employees to begin work. The annual flu vaccine is required for each flu season as well.
Preferred Qualifications
- 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
Mass General Brigham Health Plan Holding Company, Inc. 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 law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
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Mass General Brigham Health Plan
Jan 13, 2025