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