Customer Service Representative

Mass General Brigham Health Plan is a not-for-profit organization focused on advancing patient care, research, teaching, and community service. They are seeking a Customer Service Professional who will act as the primary point of contact for members and providers, ensuring exceptional customer satisfaction and first call resolution by handling inquiries and resolving complaints effectively.

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

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