What are the responsibilities and job description for the Customer Service Representative position at Mass General Brigham Health Plan?
The Opportunity
The Customer Service Professional (CSP) acts as the primary point of contact for our members, providers and other key stakeholders focusing on exceptional customer satisfaction and first call resolution.
The CSP's interact with customers to provide information and troubleshoot complex issues in response to inquiries about coverage, benefits, services, and to handle and resolve complaints.
The Customer Service Rep in this role must be committed to building customer confidence and increasing customer satisfaction by delivering to callers an
exceptional experience focused on quality and accuracy.
The CSP's will be initially trained on member demographic changes and benefit inquires. Additional member claims training will be delivered 60 days after CSP has completed benefits and eligibility training After successfully demonstrating core competencies by meeting or exceeding key performance measurements, the individual will be trained to handle Provider claims inquiries as business needs dictate.
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
The CSP is Responsible For
- Serves as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures.
- The CSP must be able to handle and demonstrate skills in handling benefits, claims and eligibility calls for the member and provider population.
- Identify customer issues/concerns rapidly and precisely
- Research required information using available resources and triage when necessary
- Handles and resolve customer inquiries and complaints, exhausting all efforts within the CSP's scope before requesting assistance
- Identify and escalate priority issues in order to create efficiencies
- Initiates follow up customer calls where necessary
- Complete call logs to record customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken
- Refer customer grievances and appeals to designated departments for further investigation
- Responsible for navigating multiple systems in order to resolve customer issues
- Acts as the primary representative for Mass General Brigham Health Plan for our customers focusing on first call resolution and customer engagement.
- - Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
Qualifications and Skills for Success
- High School Diploma or Equivalent required
- Associate's Degree in related field or Healthcare Management preferred
- Exceptional Customer Service skills, both verbal and written communication must be concise, clear, compliant, personable and professional
- Ability to multi task and prioritize
- Call Center experience a plus
- Maintain Customer Service Behavior Competencies
- Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
- Relationship Building/Caring
- Service Excellence/Accountability/Critical Thinking
Working Model Required
Monday - Friday EST hours:
- First one full Month Training Schedule: M-F 8:30 AM - 5:00 PM EST
- Post Training Schedule:9:00 AM - 5:30 PM (Mon, Tue, Wed, and Fri) with 11:30 AM - 8:00 PM (Thurs) (EST) or9:30 AM - 6:00 PM (Monday-Friday) EST
This is a remote position; a quiet, secure, stable, and compliant work station is required from within the US, with MGB provided equipment and Video required during the work week
Start Date required: June 1, 2026
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.