Customer Service Representative

Customer Service Professional

The Customer Service Professional (CSP) acts as the primary 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 CSP is responsible for serving 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. The CSP 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.

Start Date: August 10, 2026

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.

Qualifications

• High School Diploma or Equivalent required
• Associate's Degree in related field or Healthcare Management preferred
• Exceptional Customer Service skills, both verbal and written communication must be concise, clear, compliant, personable and professional
• Ability to multi task and prioritize
• Call Center experience a plus
• Maintain Customer Service Behavior Competencies
• Flexibility/Adaptability/Willingness/Team Player/Positive Attitude
• Relationship Building/Caring
• Service Excellence/Accountability/Critical Thinking

Additional Job Details

Mandatory Working Model:

• Monday - Friday EST hours:
• First one full Month Training Schedule: M-F 8:30 AM 5:00 PM EST
• Post Training Schedule: 9:00 AM 5:30 PM (Mon, Tue, Wed, and Fri) with 11:30 AM 8:00 PM (Thurs) (EST) or 9:30 AM 6:00 PM (Monday-Friday) EST

This is a remote position; a quiet, secure, stable, and compliant work station is required from within the US, with MGB provided equipment and Video required during the work week

Start Date required: August 10, 2026

On-Camera video interview required to be considered for the position

Work Location: 399 Revolution Drive

Pay Range: $19.81 - $28.30/Hourly

Grade: 3

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at View phone number on click.appcast.io.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.