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    Customer Service Professional - Somerville, United States - AllWays Health Partners

    AllWays Health Partners
    AllWays Health Partners Somerville, United States

    2 weeks ago

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    Description

    Job Description - Customer Service Professional (32 hours/week **Job Description**

    Customer Service Professional (32 hours/week) ( **Job Number:**

    **Description**

    For over 30 years, AllWays Health Partners has delivered value to our members and worked to improve access to care and coverage. As a member of Mass General Brigham, AllWays is a health plan at the forefront of innovation, advancing a highly integrated model of value-based care with one of the worlds leading health care systems. Together, we are transforming the customer experience, keeping our members and patients at the center of everything we do. Bring your unique talents and join us as we strive to create a world where all people live healthier lives.

    The Customer Service Professional (CSP) acts as the primary AllWays Health Partners point of contact for our members, providers and other key stakeholders focusing on exceptional customer satisfaction and first call resolution. The CSPs interact with customers to provide information and troubleshoot complex issues in response to inquiries about coverage, benefits, services, and to handle and resolve complaints.

    The person in this role must be committed to building customer confidence and increasing customer satisfaction by delivering to callers an exceptional experience focused on quality and accuracy.

    The CSPs will be initially trained on member demographic changes and benefit inquires. Additional member claims training will be delivered 60 days after CSP has completed benefits and eligibility training. After successfully demonstrating core competencies by meeting or exceeding key performance measurements, the individual will be trained to handle Provider claims inquiries as business needs dictate.

    **Primary Responsibilities:**

    Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures.

    The CSP must be able to handle and demonstrate skills in handling benefits, claims and eligibility calls for the member and provider population.

    Identify customer issues/concerns rapidly and precisely

    Research required information using available resources and triage when necessary

    Handle and resolve customer inquiries and complaints, exhausting all efforts within the CSPs scope before requesting assistance

    Identify and escalate priority issues in order to create efficiencies

    Initiate follow up customer calls where necessary

    Complete call logs to record customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken

    Refer customer grievances and appeals to designated departments for further investigation

    Responsible for navigating multiple systems in order to resolve customer issues

    Act as the primary representative for AllWays Health Partners for our customers focusing on first call resolution and customer engagement.

    Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.

    Maintain Customer Service Behavior Competencies

    Communication

    Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude

    Relationship Building/Caring

    Service Excellence/Accountability/Critical Thinking

    **Working Conditions:**

    Remote Work Possible

    **Qualifications**

    **Basic Requirements:**

    High School Diploma or equivalent

    4+ years in customer service environment

    Knowledge of customer service principles and practices

    Ability to resolve customers' problems and to demonstrate patience and remain courteous when faced with difficult or angry callers

    Ability to work well under pressure and in a rapidly changing environment

    **Preferred Qualifications:**

    Associates Degree or Bachelors Degree

    High school and college level courses in computers, English, or business helpful

    Bilingual (Spanish) or other

    2+ years in an HMO/Health Care Industry setting

    Knowledge of call center telephony and technology

    Proficiency with MS Office suite

    Understanding of Protected Health Information (PHI) and the necessity to maintain confidentiality of this information

    Understanding of or training in Medical terminology

    Understanding of medical coding is helpful

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