Under the general direction of Call Center Supervisor, the customer relations senior representative is responsible for providing accurate and thorough interpretation of THP Medicare Preferred benefits, claims processes, eligibility, and enrollment policies to members, providers, prospective providers, employers, and internal customers. In addition to providing accurate technical information, the Senior Customer Relations Representative is responsible for extending the lifetime of our members and providers membership through the resolution of complex customer inquiries, the facilitation of problem resolution, and acting as a member advocate by meeting or exceeding customers' expectations. The Customer Relations Senior Representative is expected to take personal and complete responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention, satisfy corporate customer service goals and objectives and serve as a role model to other customer service representatives.

Key Responsibilities/Duties – what you will be doing

Responds professionally and promptly to phone inquiries while maintaining the required performance service standards:

• Answers incoming phone calls from members and providers and adheres to department customer service expectations.
• Ensures issues are accurately and completely resolved by using available resources, including THP MP's information systems and internal contacts in other supporting departments.
• Asks probing questions and takes the opportunity to educate members and providers to avoid unnecessary repeat calls and delays.
• Provides clear and accurate documentation to ensure problem resolution.
• Responds to inquiries from other key departments in a timely manner.
• 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
• Performs additional functions as required:
• Serves as a key contributor at department meetings and occasionally lead team meetings.

Mentor to new hires

• one on one coaching while monitoring new hire's phone calls
• educate on training modules as needed
• assign buddies for new hire classes
• Works on special projects as required.
• Adheres to Tufts Health Plan's Corporate Compliance policy.
• Demonstrates strong leadership skills and is viewed as a role model:
• Assists supervisor in conducting monthly call monitoring.
• Serves as "Covering Supervisor" in supervisor's absence and seeks solutions to high queue volume, staffing needs, and problem resolution.
• Responds to escalated calls that require intervention.
• Coaches staff in resolving complex member and provider issues.
• Presents creative suggestions for improving morale, department processes, and workflows to management team. Serves as an expert with regard to member and claim knowledge and THP MP systems.

Qualifications – what you need to perform the job

EDUCATION:

• Bachelors Degree or equivalent relevant work experience is preferred.
• Verbal and written communication skills generally acquired through college or other advanced education is required.

EXPERIENCE:

• Requires one year of experience in a call center, customer service or health care setting and excellent verbal and written communication skills

SKILL REQUIREMENTS:

• Proficiency with MS Windows and proficient keyboard skills.
• Strong communication and organizational skills required as well as the ability to research and respond to a high volume of telephone and mail inquiries in a consistent and professional manner.
• Basic math, grammar, and spelling are required as well as knowledge of medical terminology is a plus.
• Must be able to work cooperatively as part of a team and requires excellent interpersonal skills and an ability to provide maximum customer service in order to promote a positive company image.
• Must be able to effectively communicate with internal and external customers in verbal and written format.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS

• Fast paced office environment handling multiple demands and exercising appropriate judgment as necessary.
• Requires a high level of initiative and independence and communication skills sufficient to communicate verbally via telephone.
• Requires ability to adapt positively to changes related to work processes, department structure, environment, and technology.
• 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.

Commitment to Diversity, Equity & Inclusion

Point32Health is committed to making diversity, equity, and inclusion part of everything we do—from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

COVID Policy

Please note: As of January 18, 2022, all employees — including remote employees — must be fully vaccinated. This position will require the successful candidate to show proof of full vaccination against COVID-19. Point32Health is an equal opportunity employer, and will consider reasonable accommodation to those individuals who are unable to be vaccinated consistent with federal, state, and local law.

Who We Are

Point32Health 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: R6165