Commonwealth Care Alliance Job Details: Member Services Representative in Boston, Massachusetts
Job Details: Member Services Representative
- Vacancy NoVN2302
Posting TitleMember Services Representative
To provide a single point of contact for questions, problem solving, and access to care, for all involved in CCA members’ care, including the Senior Care Options (SCO) and Integrated Care Organization (ICO) Programs. To provide accurate, prompt, and courteous service in response to written and telephonic inquiries, from Members, Members’ Care-Givers, Primary or Interdisciplinary Care Team Members, Pharmacies, and Vendors. To facilitate quality member care and service delivery by responding to every inquiry immediately and directly, when possible, or by collaborating with our Interdisciplinary or Primary Care Teams, Clinical Staff, and others involved in providing care for our members.
Respond to and answer all member and provider inquiries in a courteous, responsive, comprehensive, effective, and accurate manner following all departmental and organizational policies and procedures.
Participate as part of a team conducting and/or supporting outreach to members regarding benefits and eligibility requirements.
Thoroughly document all member related and prospective member interactions into CCA database for purpose of accurate tracking and analysis.
Coordinate with various roles within CCA and its interdisciplinary and/or primary care partners to ensure external and internal customer requests and questions are handled appropriately and in a timely manner.
Provide translation and interpretation when requested/approved by supervisor.
Daily tasks include: ongoing incoming and outgoing phone calls; ongoing incoming and outgoing email; ongoing use of member database and members’ electronic medical records; processing paper mail; and processing faxes.
Provide other duties as assigned.
Bachelor’s Degree or Associate's degree strongly preferred.
Bi-lingual abilities strongly preferred in one or more of the following languages: Spanish, Portuguese, Vietnamese, Haitian Creole, and/or Russian
Experience and competency working with a diverse, and disabled population
Must have experience providing customer-focused service/activities; experience answering multiple calls at one time and managing large amounts of email; experience independently problem-solving by referencing information and policies; and experience with data entry and using Microsoft Office software.- Knowledge of Massachusetts’ health care delivery system - Prior experience working in medical setting; - Prior experience working in a Call Center; - Ability to complete mail merge; - Experience using and entering data into electronic medical records.
Must have experience working in a diverse environment: colleagues, members and providers are diverse socioeconomically, ethnically, and culturally.
Must possess exceptional oral and written communication skills, including the ability to manage difficult callers and conflict.
Must be flexible and comfortable working in an environment that includes continual change for quality improvement.
Must have the ability to: develop a thorough knowledge of benefits, related payment policies, and medical terminology; work independently as well as within a team environment; prioritize work; and manage and track outstanding work and work due in the future.
The MSR position requires the ability to sit at a desk, while talking on the telephone and using the computer, for eight hours each day. The position requires the ability to focus on own work while sitting at a desk cubicle in a Call Center. The position also requires light lifting and bending, while filing member records and similar. The position might require occasional travel to contracted provider sites.
Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable).
Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.
CCA is committed to protecting the health of our workforce and our members, and we encourage flu vaccination in accordance with CDC recommendations. Individuals working in clinical care areas or in direct contact with members must provide documentation of flu vaccination, or wear a mask during flu season whenever engaged in member-facing activities.