Why This Role is Important to Us:

　　The Member Services Department provides a single point of contact for questions, problem solving, and access to care, for members of the Senior Care Options (SCO) and One Care Programs and all those involved in 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 assistswith 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.

　　What You'll Be Doing:

　　Key Responsibilities:

　　Respond 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

　　What We're Looking For:

　　Minimum Education and Experience Required:

　　Associate degree or equivalent experience.

　　Not less than one-year customer service experience.

　　Currently or recently employed in customer service, public service, as front-line health care worker, or in a contact center.

　　Experience and competent in working with a diverse disabled and elderly population

　　Must have experience providing customer-focused service and activities

　　Experience working independently while in a team environment.

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

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

　　Preferred Education and Experience:

　　A bachelor's degree in any general or health-oriented fields is preferred. Technical accreditation in the health care field (i.e., Medical Assistant | Billing and Coding) is a plus.

　　Experience in health care, the non-profit service sector, or government is preferred.

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

　　Prior experience working in a Call/Contact Center preferred

　　Knowledge, Skills & Abilities:

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

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

　　Critical thinking and sound judgement

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

　　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

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

　　Superb verbal and written communications skills in English required

　　Proficiency in at least one other language strongly preferred

　　Articulate and adept in medical terminology preferred

　　Equipment Utilized:

　　Standard Office Equipment

　　Remote Connectivity Equipment

　　Working Conditions:

　　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.

　　EEO is The Law

　　Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

　　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.