Medicare Member Service Representative

Mass General Brigham; Somerville (MA); Remote; USD 40,000 - 55,000; Full time

Job summary

A leading healthcare organization is seeking a Medicare Member Service Representative to provide exceptional customer service to Medicare Advantage plan members. This role involves handling inquiries, resolving issues, and ensuring compliance while working remotely. The ideal candidate will possess strong communication skills and a commitment to customer satisfaction.

Benefits

Flexible work options

Career growth opportunities

Competitive salaries

Qualifications

• Prior experience in customer service, preferably in healthcare or insurance.
• AHIP Certified or able to pass certification within 90 days.

Responsibilities

• Handle inbound calls from Medicare Advantage members.
• Provide accurate information regarding plan benefits and coverage.
• Document and update member records in the call center database.

Skills

Excellent verbal and written communication skills

Customer-first attitude

Strong problem-solving skills

Empathetic and patient demeanor

Education

High School Diploma or equivalent

Associate’s or Bachelor’s Degree preferred

Tools

Customer relationship management (CRM) systems

Job description

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Site: Mass General Brigham Incorporated

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.

Remote Member Service Rep Full Time roles are open with July start Dates!

Must have quiet, stable, secure, compliant working station to work remotely

Required shifts; M-F shifts will fall between 8a-8p ET, Shifts are either 8:00a-4:30p ET or 11:30a-8:00p ET

Job Summary

About Us

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.

The Opportunity

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.

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.
  
  

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 (if Applicable)

Working Conditions and Shifts Requirements

• 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 remotely
  
  

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 (857)-282-7642.

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.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care, Non-profit Organizations, and Government Administration

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