Remote Member Service Representative

at USA Medical Staff (view profile)
Location Remote Position, Massachusetts
Date Posted September 22, 2021
Category Administration
Job Type Full Time


Salary range $ 39,520 - $ 45,760 - DOE


Associates Degree or Post High School Training/ Certification/ Education Required

1-3 years customer service experience

Prior experience working in the health care industry front lines or medical setting

Computer literacy a must, demonstrated ability to work with multiple complex systems simultaneously

Job Description
The Member Services Department provides a single point of contact for questions, problem solving, and
access to care, for members of the Senior Care Options (SCO) and One Care Programs and all those involved
in CCA members’ care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all constituents; including enrolled and prospective members, providers, Commonwealth Care Alliance internal workforce, and employees of state and federal agencies. The MSR serves as a facilitator for member inquiries and assists with accessing care. This position focuses on educating members on health plan benefits, products, and services, and will triage calls to the appropriate destination. The MSR will also report to and receive daily instruction from a Contact Center Supervisor. After training, the MSR will be expected to have a solid understanding of operational, telecom, and IT related systems specific to Contact Centers in the health care industry. This position is remote and may offer some scheduling flexibility.

The Ideal candidate:
We are looking for a tenacious yet personable and compassionate individual who is able to solve complex problems while delivering outstanding customer service to our members. If you are reliable, kind, and thrive in a challenging work environment, you could be a great addition to our team.

Key Responsibilities
Respond and effectively triage member phone calls in order to accurately and timely route to appropriate area
Work with care management team to address the needs of members, caregivers and other CCA constituents
Provide timely and accurate information regarding member benefits and services including Continuity of Care
Meticulously document all member and prospective member interactions in a Centralized Electronic System
Responsible for the scheduling of member appointments, transportation, translation and interpretation services
Initiates Prior Authorization Intake process
Attends to erroneous member billing discrepancies
Assist with member mailings and respond to questions about mailings
Responsible for providing members with any requested documents including provider listings in their areas
Complete comprehensive appeal and grievance intakes.
Assist with timely resolution of quandaries or complaints conveyed by member and members’ representative
Responsible for conducting in dept. research to provide accurate and informed resolution to members inquiries
Assist in the collection of supporting data and documentation relevant to member’s care
Serve as a facilitator connecting members to their CCA providers thru Telemedicine accessibility
Responsible for educating members on benefits and services available as well as protocols and requirements
Responsible for acting in compliance with HIPAA, State and Federal regulations when assisting CCA members
Responsible for meeting departmental expectations, benchmarks, goals and Key performance indicators
Other responsibilities and duties as assigned


Company Culture & Perks

Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.

Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.

Drop files here browse files ...