Member Services Team Lead - Senior Products
Company: Point32Health
Location: Arlington
Posted on: May 21, 2023
Job Description:
Under the general direction of Call Center Member Support
Supervisor, the Member Services Team Lead is responsible for
accurately and thoroughly interpreting THP Medicare Preferred
benefits, claims processes, eligibility, and enrollment policies to
assist Help Desk, member and provider reps with calls from members,
providers, pharmacies and internal customers. In addition, the
Member Services Team Lead is responsible for assisting Customer
Relations Help Desk Representatives with resolution of complex
inquiries and facilitation of problem resolution. The Member
Services Team Lead is expected to act as a resource/educator and to
serve as a role model to other customer service representatives.
Must be flexible in regard to scheduling. Requires ability to adapt
positively to changes related to work processes, department
structure, environment and technology.KEY
RESPONSIBILITIES/ESSENTIAL FUNCTIONS
- Responds professionally and promptly to phone inquiries while
maintaining the required performance service standards:
- Answer incoming phone calls from internal customers including
member service reps, provider service reps and other
departments.
- Adheres to department customer service expectations.
- Ensures issues are accurately and completely resolved by using
available electronic resources including THPMP's on-line reference
tools and, external website as well as consulting members of the
leadership team and internal contacts in other key
departments.
- Educate callers and reps to avoid unnecessary repeat calls and
delays.
- Adheres to assigned schedules to ensure appropriate phone
coverage.
- Achieves individual performance expectations to contribute to
the cost-effective delivery of high quality service. Strives to
meet or exceed the department's established service standards.
- Serves as an expert with regard to member and claim knowledge
and THP MP Systems.
- Performs QC of reviewed legal documents.
- Review scored calls for potential disputes.
- Perform side-by-side evaluations.
- Assign work to the Help Desk reps from both the Help Desk
MACESS and IBM Notes boxes.
- Track educations identified by the Help Desk and inform
appropriate supervisor/Team Lead.
- Responds to e-mail and actiongram inquiries from other key
departments in a timely manner when necessary.
- Clearly and accurately documents all issues, resolution steps
and follow up actions.
- Special projects as assigned.
- Adheres to Tufts Health Plan's Corporate Compliance
policy.
- Act as covering supervisor a minimum of one night per week and
at other points as needed.
- Answer Help Desk calls and Escalations during 3 hours of
scheduled queue time per day and at other points as needed for back
up.Qualifications - what you need to perform the jobEDUCATION:
(Minimum educations & certifications required)
- High School Diploma/GED or equivalent relevant work experience
is required. EXPERIENCE: (Years of experience)
- A minimum of 1 year experience within the THPMP call center or
other internal department working with senior products is
required.SKILL REQUIREMENTS: (Include interpersonal skills)
- Proficiency with MS Windows and proficient keyboard
skills.
- Strong verbal and written communication and organizational
skills required as well as the ability to research and respond to a
high volume of telephone, electronic and mail inquiries in a
consistent and professional manner.
- Basic math, grammar, and spelling are required.
- Knowledge of medical terminology is a plus.
- Must be able to balance working both independently as well as
collaboratively with the team.WORKING CONDITIONS AND ADDITIONAL
REQUIREMENTS (include special requirements, e.g., lifting, travel,
overtime)
- Fast paced office environment handling multiple demands.
- Open cubicle work setting with a personal computer.
- Schedule rotation involving evening and weekends.
- Involves simultaneous use of a telephone headset, and
PC/keyboard for long periods of time in order to document and
communicate efficiently along with long periods of sitting.
- Occasional overtime may be requested.CONFIDENTIAL DATA: All
information (written, verbal, electronic, etc.) that an employee
encounters while working at Tufts Health Plan is considered
confidential. Will be exposed to and required to deal with highly
confidential and sensitive material and must adhere to corporate
compliance policy and department guidelines/policies and all
applicable laws and regulations at all times. - About
UsPoint32Health is a leading health and wellbeing organization,
delivering an ever-better personalized health care experience to
everyone in our communities. At Point32Health, we are building on
the quality, nonprofit heritage of our founding organizations,
Tufts Health Plan and Harvard Pilgrim Health Care, where we
leverage our experience and expertise to help people find their
version of healthier living through a broad range of health plans
and tools that make navigating health and wellbeing easier.We enjoy
the important work we do every day in service to our members,
partners, colleagues and communities.This job has been posted by
TalentBoost on behalf of Point32Health. TalentBoost is committed to
the fundamental principle of equal opportunity and equal treatment
for every prospective and current employee. It is the policy of
TalentBoost not to discriminate based on race, color, national or
ethnic origin, ancestry, age, religion, creed, disability, sex and
gender, sexual orientation, gender identity and/or expression,
military or veteran status, or any other characteristic protected
under applicable federal, state or local law.Req ID: R6647
Keywords: Point32Health, Arlington , Member Services Team Lead - Senior Products, Other , Arlington, Massachusetts
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