Member service rep

Job Overview :

Under the general direction of the Call Center Supervisor, the Member Services Representative is responsible for providing accurate and thorough interpretation of Tufts Health Plan (Tufts HP) benefits, claims processes, eligibility, and enrollment policies to members, employers, and internal customers.

In addition, the Member Services Representative is responsible for resolution of complex customer inquiries, the facilitation of problem resolution, and meeting or exceeding customers’ expectations.

The Member Services Representative presents a consistent and professional demeanor to all callers and internal customers and is expected to identify opportunities to improve customer service and efficiency.

The Member Services Representative is expected to take responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention, and satisfy corporate customer service goals and objectives.

Key Responsibilities / Duties what you will be doing

• Receives and responds to a high volume of incoming telephone calls from members, prospective members, employers, and internal Tufts HP staff.
• Efficiently and effectively processes member calls. This includes :
• Accesses the most appropriate source of information and proficiently resolving the member’s concern.
• Accurately documents the complete encounter and maintains a professional and supportive attitude throughout the call.
• Asks probing questions and takes the opportunity to educate members to avoid unnecessary repeat calls.
• Investigates member complaints and performs front-line analysis and intervention when appropriate.
• Meet or exceed department established key performance indicators.
• Adheres to assigned schedules to ensure appropriate phone queue coverage.
• Demonstrates strong written (e.g., documents calls accurately and comprehensively) and verbal skills.
• Employs active listening skills, demonstrates patience and empathy, and is able to handle difficult customers tactfully, courteously and professionally.
• Strives for improved efficiency for processing member issues.
• Interacts and forms contacts with other Tufts HP departments in order to resolve issues.
• Participates in initiatives and / or responds to requests for help to contribute to team and department success.
• Assists in mentoring new staff as directed.
• Assist with department projects as needed.

Qualifications what you need to perform the job

EDUCATION : (Minimum educations & certifications required)

High School Diploma or equivalent required. Associates degree or equivalent work experience preferred.

EXPERIENCE : (Years of experience)

• 6-12 months of relevant experience.
• Preferred customer service experience in health care, call center, retail, hospitality or corporate office. Knowledge of medical terminology is preferred.
• Prior experience training and working in a virtual / remote setting is strongly preferred.

SKILL REQUIREMENTS : Technical Skills :

Technical Skills :

• Must have strong computer and telephone multitasking skills
• Must have the ability to navigates through multiple systems
• Accuracy in data input and documentation
• Proficiency with MS Windows
• Proficient keyboard skills

Interpersonal Skills :

• Excellent verbal and written communication skills are required
• Strong organizational skills
• Ability to research and respond to a high volume of telephone inquiries in a consistent and professional manner
• Basic math, grammar, and spelling are required
• Ability to work under pressure and with attention to changing priorities
• Must be able to work cooperatively as part of a team
• Bilingual preferred

WORKING CONDITIONS A ND ADDITIONAL REQUIREMENTS

• Fast paced office environment handling multiple demands exercising appropriate judgment as necessary.
• Requires a high level of initiative and independence and communication skills sufficient to communicate verbally via telephone.
• Must adapt positively to changes related to work processes, department structure, environment, and technology.
• Involves simultaneous use of a telephone headset, and PC / keyboard for long periods of time in order to document and communicate efficiently.
• Requires long periods of sitting and occasional overtime may be requested.
• May require ability and willingness to work from home.

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity

Point32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do from product design to the workforce driving that innovation.

Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts.

Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent.

We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities.

At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee.

It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and / or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.

Req ID : R8229

Last updated : 2024-08-22