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POST DATE 9/13/2016
END DATE 11/1/2016

Fallon Health Worcester, MA

Worcester, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
High School Diploma or GED


responsibilities outlined below, a spot on this team also represents one of the best places to grow your career. With demonstrated initiative and strong performance, you will gain exposure across a multitude of functions and endless opportunities for advancement. Member Services has proven to be a launching pad of development that has translated into long term careers with advancement opportunities throughout the company in a number of different key area s such as; Sales and Marketing, Provider Relations, Care Services, Pharmacy and other functions of the operation.

As a brand champion and valued member ambassador you will get extensive training and support through a skill based progression training program that includes a blended learning curriculum and personalized coaching plan. We are always looking for top talent in these roles so feel free to pass this along to friends, family and colleagues that you think qualify.

We are currently hiring for a 9:30 am - 6:00 pm shift.


Position Overview:

The Member Services Representative is accountable for successfully addressing member and provider inquiries received through Fallon Community Health Plan s 1-800 numbers, as well as, providing direction on Plan policies, procedures, and benefits.

Some key responsibilities include:

* Ownership for development of knowledge and skills, as training program provides material and framework for success.

* Ownership for customer satisfaction. Member Service Representatives are the primary liaison for our members to obtain the information or support they need As such, our representatives are expected to fully understand member/ provider needs, and within corporate/ department policies, take whatever action is necessary to fully satisfy the inquiry.

* Clear and concise documentation of call detail for tracking of member/ provider contacts.

* Identification and communication of trends that are indicative of enterprise service issues.

* Escalation of member/provider concerns and servicing issues.

* Appropriate execution of corporate and department policies/ practices.


* High school diploma required, Bachelor s degree or advanced education desirable

* 2+ years professional work experience preferably in a customer facing inbound call-center setting.

* The ability to multitask and leverage strong typing skills and a high proficiency with MS Word, MS Excel and system data entry are essential tools for success in this role

About Fallon Health:

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation s top health plans, and is the only health plan in Massachusetts to have been awarded Excellent Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit

Fallon Health is an equal opportunity employer. It is very important for us to maintain a consistant hiring process for every candidate. In addition, we are also a government contractor with requirements to report on our Affirmative Action planning. To that end, we require everyone to apply online.

If you do not have access to a computer or need assistance completing the application process, please contact Human Resources at 1-508-368-9893 (TRS 711).