Our client in Quincy, MA is anticipating a spike in call volume and are looking to bring on Member Service Specialists to provide best-in-class service to all constituents of the Medicare Advantage program, including but not limited to members, individual members, brokers, providers / pharmacists, vendors and internal staff.
This is a contract role with 5 week (paid) training starting 10/14/19 and the assignment will run through at least 2/28/20.
Duties and Responsibilities
· Receive and respond to a high volume of incoming calls. Provide accurate and thorough information relative to Medicare Advantage benefits, eligibility and enrollment policies to members, brokers, providers and internal customers.
· Answer complex product billing, enrollment, claims and eligibility questions
· Understand and relay information and resolves issues regarding contract riders, member programs and all vendor relationships.
· Capture and document customer feedback; receive, resolve, and route complaints as defined by Department, Corporate and Regulatory policies, procedures, and guidelines.
· Accurately handle appeals process inquiries. Consult with appropriate staff from all levels within the department well as with Appeals to effectively address a member’s inquiry.
· Protect member privacy and confidentiality by consistently maintaining full compliance with all HIPAA regulations. Verifies member information and validates appropriateness of broker contacts in order to handle broker inquiries via telephone and in written format provided there is appropriate authorization on file if the broker is requesting member information.
· Maintains thorough understanding of policies, products and systems.
High school diploma and a minimum of 3years of customer service experience in a managed care environment or 1 year of customer service experience are required, along with the successful completion of a comprehensive Member Services training program.