Member Services Representative

The Member Services Department provides a single point of contact for questions, problem solving, and

The Member Services Department provides a single point of contact for questions, problem solving, andaccess to care, for members of the Senior Care Options (SCO) and One Care Programs and all those involvedin CCA members’ care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all constituents; including enrolled and prospective members, providers, Commonwealth Care Alliance internal workforce, and employees of state and federal agencies. The MSR serves as a facilitator for member inquiries and assists with accessing care. This position focuses on educating members on health plan benefits, products, and services, and will triage calls to the appropriate destination. The MSR will also report to and receive daily instruction from a Contact Center Supervisor. After training, the MSR will be expected to have a solid understanding of operational, telecom, and IT related systems specific to Contact Centers in the health care industry. This position is remote and may offer some scheduling flexibility.The Ideal candidate:We are looking for a tenacious yet personable and compassionate individual who is able to solve complex problems while delivering outstanding customer service to our members. If you are reliable, kind, and thrive in a challenging work environment, you could be a great addition to our team. Key ResponsibilitiesRespond and effectively triage member phone calls in order to accurately and timely route to appropriate area

Work with care management team to address the needs of members, caregivers and other CCA constituents

Provide timely and accurate information regarding member benefits and services including Continuity of Care

Meticulously document all member and prospective member interactions in a Centralized Electronic System

Responsible for the scheduling of member appointments, transportation, translation and interpretation services

Initiates Prior Authorization Intake process

Attends to erroneous member billing discrepancies

Assist with member mailings and respond to questions about mailings

Responsible for providing members with any requested documents including provider listings in their areas

Complete comprehensive appeal and grievance intakes.

Assist with timely resolution of quandaries or complaints conveyed by member and members’ representative

Responsible for conducting in dept. research to provide accurate and informed resolution to members inquiries

Assist in the collection of supporting data and documentation relevant to member’s care

Serve as a facilitator connecting members to their CCA providers thru Telemedicine accessibility

Responsible for educating members on benefits and services available as well as protocols and requirements

Responsible for acting in compliance with HIPAA, State and Federal regulations when assisting CCA members

Responsible for meeting departmental expectations, benchmarks, goals and Key performance indicators

Other responsibilities and duties as assigned

Expectations of all EmployeesDemonstrate integrity by working with passion, commitment, and honesty, acting in the best interests ofcolleagues and members. Demonstrate accountability by delivering on commitments and contributing to an empowering environment where the focus is on member satisfaction by providing best in class service. Recognize and respect diversity in all forms. Strive for excellence in the fulfillment of CCA’s mission through quality, innovation, and continuous learning. Represent CCA and its clinical affiliates with professionalism. Keep current and proficientwith necessary skills and knowledge including technology. Adhere to all applicable compliance requirements such as CCA’s Policy & Procedures. Ensure confidentiality of member and company proprietary information is maintainedMinimum Education RequiredAssociates Degree or Post High School Training/ Certification/ Education Required. Preferred Educational ExperienceAn Associate or bachelor’s degree in any general or health-oriented fields is preferred. Also, experience in health care, the non-profit service sector, or government is preferred. Technical accreditation in the health care field (i.e. Medical Assistant | Billing and Coding) is a plus.Minimum Years’ Experience Required1-3 yearsMinimum Experience Not less than one-year customer service experience.Knowledge, Skills and AbilitiesExperience and competent in working with a diverse disabled and elderly population

Must be passionate about serving others and able to show empathy to distress individuals

Must have experience providing customer-focused service and activities

Experience working independently while in a team environment.

Skilled in problem solving by referencing departmental standard operating procedures and workflows.

Critical thinking and sound judgement

Prior experience working in the health care industry front lines or medical setting preferred

Prior experience working in a Call/Contact Center preferred

Must be resilient and adaptable working in an environment that includes continuous change

Experience working in a quality-focused environment with a rigorous quality assurance measuring program

Proven proficiency working in a metrics, benchmarks and goals driven in an active work environment.

Reliability and punctuality are a must

Computer literacy a must, demonstrated ability to work with multiple complex systems simultaneously

Ability to document information clearly and efficiently using medical terminology a must

Excellent interpersonal skills required and ability to interact professionally

Experience working in a diverse environment: socioeconomically, ethnically, and culturally

Capacity to kindly and respectfully assist all our constituents including irate and difficult callers, with the uppermost level of customer service.

Preferred Previous Work Experience: Currently or recently employed in customer service, public service, as front-line health care worker, or in a contact center. Equipment Utilized Standard Office Equipment

Remote Connectivity Equipment

Language RequirementsSuperb verbal and written communications skills in English required

Articulate and adept in medical terminology preferred

Test proven proficiency in at least one other language strongly preferred

Physical RequirementsAbility to sit for long periods of time

Light lifting, and bending

Working ConditionsThe MSR position requires the ability to sit at a desk, while talking on the telephone and using the computer, foreight hours each day. The position requires the ability to focus on own work while sitting at a desk cubicle in aCall Center. The position also requires light lifting and bending, while filing member records and similar. Theposition might require occasional travel to contracted provider sites.Job Title for Posting: Member Services Representative ID: 2020-3431 External Company Name: Commonwealth Care Alliance, Inc. External Company URL: http://www.commonwealthcarealliance.org/ Actual Work Location: Lafayette City Center, Boston, MA