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) Boston, MA

Company
Massachusetts General Hospital(MGH)
Job Classification
Full Time
Company Ref #
3023758
AJE Ref #
575979490
Location
Boston, MA
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
Education
High School Diploma or GED

JOB DESCRIPTION

APPLY
SUMMARY 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.



ESSENTIAL FUNCTIONS

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

Communication

Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude

Realationship Building/Caring

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.



MINIMUM REQUIREMENTS

KNOWLEDGE AND EDUCATION

REQUIRED:

High School diploma or GED required,

PREFERRED/DESIRED:

Associates Degree or Bachelors Degree

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

Bilingual (Spanish) or other

EXPERIENCE

REQUIRED:

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/DESIRED:

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

INCUMBENT/CANDIDATE PROFILE:

SKILLS/COMPETENCIES

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

OTHER SKILLS

Proficiency in Spanish or other language skills desirable

Understanding of or training in Medical terminology

Understanding of medical coding is helpful



INDEPENDENT ACTION

Under direct supervision. This role is highly regulated and measured using performance metrics (productivity, quality, timeliness).



ORGANIZATIONAL RELATIONSHIPS/SCOPE

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.