BFT CUSTOMER SERVICE PROFESSIONALS NEEDED AT NHP
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POST DATE 8/25/2016
END DATE 10/13/2016
Massachusetts General Hospital(MGH)
JOB DESCRIPTIONSUMMARY OF POSITION
The Customer Service Professional (CSP) acts as the primary Neighborhood Health Plan 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.
This is a temporary to permanent opportunity. Hours for training are Monday through Friday 8:30am to 5:00pm, once training is complete hours will change to 9:30am to 6pm. NHP is located on 253 Summer Street in Boston MA and will be moving to Assembly Row in Somerville December 2016. Temporary employees will not be benefits eligible. The position is expected to start October 3, 2016.
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.
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 NHP 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
Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
Service Excellence/Accountability/Critical Thinking
DEPARTMENT SPECIFIC/NON-ESSENTIAL FUNCTIONS
Other duties as assigned with or without accommodation.
WORKING CONDITIONS AND PHYSICAL EFFORT
Work is normally performed in a typical office work environment.
KNOWLEDGE AND EDUCATION
High School diploma or GED required,
Associates Degree or Bachelors Degree
High school and college level courses in computers, English, or business helpful
Bilingual (Spanish) or other
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
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
Ability to resolve customers' problems and to demonstrate patience and remain courteous and professional when faced with difficult or angry callers
Ability to work well under pressure
Respects the talent and unique contribution of every individual, culture and ethnic group and treats all people in a fair and equitable manner
Accountability: Keeps commitments to customers and others, Accepts responsibility for actions, Assumes ownership regardless of where an issue surfaced
Critical Thinking: self-directed, self-disciplined, self-monitored, and self-corrective thinking, Effective communication and problem solving abilities
Excellent listening, verbal and written communication
Energetic, friendly, approachable, and professional demeanor
Attention to detail
Demonstrates NHP Core Values of Service Excellence, Accountability, Quality Care, Diversity, and Relationships
Exercises self-awareness, monitors impact on others, is receptive to and seeks out feedback, uses self-discipline to adjust to feedback.
CERTIFICATION OR CONDITIONS OF EMPLOYMENT
Pre-employment background check
CORI background check, if applicable
Proficiency in Spanish or other language skills desirable
Understanding of or training in Medical terminology
Understanding of medical coding is helpful
Under direct supervision. This role is highly regulated and measured using performance metrics (productivity, quality, timeliness).
This position will report into a Customer Service Supervisor and will be part of the Customer Experience Team.
Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged.