Member Specialist

Under the general direction of Call Center Supervisor the Member Specialist 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 to providing accurate technical information, the Member Specialist is responsible for resolution of complex customer inquiries, the facilitation of problem resolution, and acting as a member advocate by meeting or exceeding customers' expectations.

EDUCATION: (Minimum educations & certifications required)
HS Diploma / GED equivalency required

EXPERIENCE: (Years of experience)
Minimum of six months experience or college degree required.

SKILL REQUIREMENTS: (Include interpersonal skills)

Proficiency with MS Windows.
Strong verbal and written communication skills.
Strong organizational skills
Basic math, grammar, and spelling
Knowledge of medical terminology is preferred
Ability to work under pressure and with attention to changing priorities.
Work cooperatively as part of a team
Strong interpersonal skills and an ability to provide excellent customer service in order to promote a positive company image.
Effectively communicate with internal and external customers in verbal and written format

Customer Service

Receives and responds to a high volume of incoming telephone calls from members and internal customers.
Efficiently and effectively processes member calls, including: accessing the most appropriate source of information; proficiently resolving the members concern; accurately documenting the complete encounter and maintaining a professional and supportive attitude throughout the call.
Provides orientation, by telephone, to new members regarding Tufts HP HMO, POS and PPO benefits, eligibility and enrollment policies and procedures.
Interacts and forms contacts with other THP shared departments in order to resolve member issues.
Demonstrates strong written (e.g., documents calls accurately and comprehensively) and verbal skills.
Strives to meet or exceed department established quality service standards. Special attention to First Call Resolution.
Employs active listening skills, demonstrates patience, and is able to handle difficult customers tactfully, courteously and professionally.
Counsels members terminating group coverage on COBRA.
Adheres to assigned schedules to ensure proper phone coverage, which contributes to optimal service levels for the call center.

90%
Team Player/ Ongoing Development:

Participates in initiatives and/or responds to requests for help that contribute to team and department success.
Offers and seeks assistance from team members to ensure accuracy and to further develop knowledge
Maintains and enhance knowledge to THP products, services and systems to provide comprehensive service to the members.

10%

If interested, please apply online at http://track.tmpservice.com/ApplyClick.aspx?id=1373037-1867-4349