New

Medicare Member Service Representative

Mass General Brigham (Enterprise Services)
United States, Massachusetts, Boston
Feb 25, 2025
The Opportunity Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated. Principal Duties and 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. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. 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. 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 employment. Skills/Abilities/Competencies 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. Excellent verbal and written communication skills 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. Required Shifts and Working Model Shifts; 8a-430p or 830a-5p Remote position requires M-F Eastern Business Hours and requires stable secure, quiet, HIPPA compliant work station Reliable internet with plug-in ethernet/network cable and a dedicated workspace in your home; MGB will provide all employee MGB issued equipment. Must have a quiet workspace free of distractions to ensure full attention to the member and to comply with MGBHP's policy for safeguarding protected member information: HIPPA and PHI. *Diversity Statement* As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve. At Mass General Brigham, we believe in equal access to quality care, employment and advancement opportunities encompassing the full spectrum of human diversity: race, gender, sexual orientation, ability, religion, ethnicity, national origin and all the other forms of human presence and expression that make us better able to provide innovative and cutting-edge healthcare and research. Mass General Brigham Incorporated 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.