Medicare Member Service Representative

Medicare Member Service Representative

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

As a Medicare Member Service Rep, you will play a vital role in providing exceptional customer service and support to our Medicare Advantage plan members. Your primary responsibility will be to handle inbound calls from members, addressing their inquiries, resolving issues, and assisting with plan-related information. With your comprehensive knowledge of Medicare Advantage plans and excellent communication skills, you will ensure a positive experience for all callers while upholding regulatory compliance and meeting performance targets.

Responsibilities

• Answer inbound calls for Medicare Advantage members to support line of business objectives, product, benefit administration, process improvement, efficiency, and above all, a first in class customer experience.
• Participate in member outreach campaigns as directed.
• Ability to work as a team player on cross-functional process improvement teams within the organization.
• This position will maintain, ensure, and foster an environment that enhances and promotes compliance, and conformance to all relevant federal, state, and local laws, rules, and regulations applicable to the company's State and Federal contracts for MGBHP's Medicare Advantage (MA) product offerings.
• Ability to cross-train on other products/Lines of Business.
• Acts as a member advocate to internal departments regarding issues, while understanding the underlying root cause and applicable regulatory requirements.
• Reads, interprets, and identifies necessary next steps related to complex member questions or issues.
• Provide accurate and detailed information regarding plan benefits, coverage, and eligibility criteria.
• Address and resolve inquiries, concerns, and issues raised by plan members, ensuring high customer satisfaction.
• Maintain a comprehensive understanding of Medicare Advantage plans, network providers, prescription drug coverage, and other related services.
• Document and update member records Mass General Brigham Health Plans call center database, ensuring accuracy and completeness of information.
• Collaborate with other team members, including supervisors, team leads, and other departments, to resolve complex member issues or escalate them appropriately.
• Meet or exceed performance metrics, including call quality, average handling time, first call resolution, and customer satisfaction scores.
• Continuously improve knowledge and stay updated with changes in Medicare Advantage plans, policies, and procedures through training programs and resources.
• Identify opportunities for process improvement and contribute to the development of best practices within the call center.

Qualifications

• High School Diploma required, or equivalent work experience in healthcare, customer service, or related fields. Associate's or Bachelor's Degree preferred.
• Prior experience in customer service, preferably in the healthcare or insurance industry, Medicare or Medicare Advantage, are a plus.
• AHIP Certified or able to pass the AHIP certification within 90 days of training completion

Skills/Abilities/Competencies

• Excellent verbal and written communication skills
• Bi-lingual a plus
• Customer-first attitude and compassion for people
• Empathetic and patient demeanor to ensure effective communication and build rapport with callers.
• Excellent work ethic and adherence to work schedule.
• Ability to work independently and hold yourself accountable for your performance.
• Exceptional attention to detail, with the ability to organize and prioritize. Ownership and accountable mentality.
• Able to navigate multiple computer programs at one time.
• Proficient computer skills and familiarity with call center software, databases, and customer relationship management (CRM) systems.
• The ability to communicate complex ideas clearly and effectively to diverse audiences.
• Strong problem-solving skills to address member inquiries, resolve issues, and provide appropriate solutions.
• Able to deescalate calls as needed.
• Ability to multitask and handle a high volume of calls while maintaining a professional and composed attitude.
• Knowledge of Medicare Advantage plans, Medicare regulations, and healthcare terminology is highly desirable.
• Ability to adapt to changing policies, procedures, and technologies in the Medicare Advantage industry, especially as it relates to CMS

Additional Job Details

• Required shifts; M-F shifts will fall between 8a-8p ET, must be open based on business needs
• Shifts; 8:00a-4:30p ET or 11:30a-8:00p ET
• July start date required
• Must have quiet, stable, secure, compliant working station to work remote

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

EEO Statement

Mass General Brigham Incorporated 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.