Member Services Rep - Commercial

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Basic Job Info

Begin Date
End Date
Base Pay
Employment Type
Manages Others
Relocation Covered

Job Description

Under the general direction of the Call Center Supervisor, the Member Services Representative is responsible for providing accurate and thorough interpretation of Tufts Health Plan (Tufts HP) 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.

Receives and responds to a high volume of incoming telephone calls from members, prospective members, employers, and internal Tufts HP staff.
 Efficiently and effectively processes member calls. This includes:
o Accesses the most appropriate source of information and proficiently resolving the member's concern.
o Accurately documents the complete encounter and maintains a professional and supportive attitude throughout the call.
o Asks probing questions and takes the opportunity to educate members to avoid unnecessary repeat calls.
o Investigates member complaints and performs front-line analysis and intervention when appropriate.
o 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 Tufts HP 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.

EDUCATION: (Minimum educations & certifications required)
 High School Diploma or equivalent required. Associates degree or equivalent work experience preferred.
EXPERIENCE: (Years of experience)
 6-12 months of relevant experience.
 Preferred customer service experience in health care, call center, retail, hospitality or corporate office. Knowledge of medical terminology is preferred.
Technical Skills:
 Must have strong computer and telephone multitasking skills
 Must have the ability to navigates through multiple systems
 Accuracy in data input and documentation
 Proficiency with MS Windows
 Proficient keyboard skills
Interpersonal Skills:
 Excellent verbal and written communication skills are required
 Strong organizational skills
 Ability to research and respond to a high volume of telephone inquiries in a consistent and professional manner
 Basic math, grammar, and spelling are required
 Ability to work under pressure and with attention to changing priorities
 Must be able to work cooperatively as part of a team
 Bilingual preferred
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel,
 Fast paced office environment handling multiple demands exercising appropriate judgment as necessary.
 Requires a high level of initiative and independence and communication skills sufficient to communicate verbally via telephone.
 Must adapt positively to changes related to work processes, department structure, environment, and technology.
 Involves simultaneous use of a telephone headset, and PC/keyboard for long periods of time in order to document and communicate efficiently.
 Requires long periods of sitting and occasional overtime may be requested.
 May require ability and willingness to work from home.
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy and department guidelines/policies and all applicable laws and regulations at all times.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Job Requirements

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