Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we are at Point32Health, click here{rel="nofollow" https:="" youtu.be="" s5i_hgoecjq="" ""="" target="" _blank""=""}.

Job Summary

Under the general direction of the Service Center Supervisor, the Member Services Representative is responsible for providing accurate and thorough interpretation of Point32Health benefits, claims processes, eligibility, and enrollment policies to members, employers, and internal customers. In addition, the Member Services Representative is responsible for resolution of complex customer inquiries, the facilitation of problem resolution, and meeting or exceeding customers' expectations. The Member Services Representative presents a consistent and professional demeanor to all callers and internal customers and is expected to identify opportunities to improve customer service and efficiency. The Member Services Representative is expected to take responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention, and satisfy corporate customer service goals and objectives.

Key Responsibilities/Duties -- what you will be doing

• Receives and responds to a high volume of incoming telephone calls from members, prospective members, employers, and internal Point32Health staff.
• Efficiently and effectively processes member calls. This includes:
  • Accesses the most appropriate source of information and proficiently resolving the member's concern.
  • Accurately documents the complete encounter and maintains a professional and supportive attitude throughout the call.
  • Asks probing questions and takes the opportunity to educate members to avoid unnecessary repeat calls.
  • Investigates member complaints and performs front-line analysis and intervention when appropriate.
  • Makes necessary outgoing phone calls to resolve member related inquiries.
• Meet or exceed department established key performance indicators.
• Adheres to assigned schedules to ensure appropriate phone queue coverage.
• Demonstrates strong written (e.g., documents calls accurately and comprehensively) and verbal skills.
• Employs active listening skills, demonstrates patience and empathy, and is able to handle difficult customers tactfully, courteously and professionally.
• Strives for improved efficiency for processing member issues.
• Interacts and forms contacts with other Point32Health departments in order to resolve issues.
• Participates in initiatives and/or responds to requests for help to contribute to team and department success.
• Assists in mentoring new staff as directed.

• Assist with department projects as needed.

   

Qualifications -- what you need to perform the job

EDUCATION:

• High School Diploma or equivalent required. Associates degree or equivalent work experience preferred.

   

EXPERIENCE:

6-12 months of relevant experience.

Preferred customer service experience in health care, call center or co