Note: The job is a remote job and is open to candidates in USA. Mass General Brigham is a not-for-profit healthcare organization supporting patient care, research, teaching, and community service. The Customer Service Representative serves as the primary contact for members, providers, and other stakeholders, resolving inquiries and complaints related to coverage, benefits, eligibility, claims, and services while delivering accurate, high-quality customer experiences.
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
Skills
- 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
- Associate's Degree in related field or Healthcare Management
- Call Center experience a plus
Benefits
- Remote work within the US
- MGB-provided equipment
- Initial training on member demographic changes and benefit inquiries
- Additional member claims training delivered approximately 60 days after completing benefits and eligibility training
- Comprehensive benefits
- Career advancement opportunities
- Differentials
- Premiums
- Bonuses as applicable
- Recognition programs
Company Overview