Member & Provider Service Representatives - Work from Home

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Positions are full-time, remote

Hours: Monday-Friday between 8AM and 6:00PM EST. Specific schedule assigned after training based on the needs of the department at that time. Hours for the 12 week training period are 9:30AM to 6PM.

Hourly rate: $19.50 per hour

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary

In this role, you will serve as the first line of support for our stakeholders by providing accurate and thorough information to current and prospective members, providers and internal customers about our various health plans. In this role, you’ll make a difference for others every day. This role has also proven to be an excellent starting point for long-term growth and advancement in our company.

Our Investment In You

• High-performing representatives may be eligible for promotion and pay increases within their first year through our Career Progression program
• Annual Commitment to Service bonus for Customer Care representatives, program requirements apply
• WellSense is committed to offering team members the opportunity to grow their career within the company. We encourage team members to pursue new roles within the company and qualified internal candidates are given preference when possible.
• We believe in recognizing and rewarding outstanding performance and dedication to our members. Various department specific and company-wide reward and recognition programs are in place to support this commitment.
• Bring your enthusiasm and people skills, and we will train you on the health insurance business and how to confidently resolve inquiries.
• Paid 12-week training period
• New hire buddy program
• Dedicated Team Assist Line to support complex/challenging calls in real time
• Robust training and skills development opportunity through Ulysses Learning, a leader in customer service and call center learning programs
• One-on-one coaching and mentoring from dedicated training and quality professionals
• We are proud of our comprehensive employee benefits and generous paid time off program.
• Team members are encouraged to participate in a variety of engagement activities including our Business Resource Groups (BRGs), where you can connect with colleagues, grow professionally and share your experiences.
  

Key Functions Of The Job

• Customer Interaction & Problem Resolution:
  
  

Own each customer interaction by utilizing the appropriate resources to accurately interpret and respond to inquiries. Deliver outstanding, empathetic service that fosters trust, builds loyalty, and contributes to member retention.

• Call Management:
  
  

Respond to a high volume of inbound calls from members and providers, addressing a wide range of topics. Calls may vary significantly in length and complexity, requiring adaptability and attention to detail.

• Communication & Conflict Resolution:
  
  

Apply strong interpersonal and conflict-resolution skills to manage challenging calls with professionalism, courtesy, and empathy.

• Accurate Documentation:
  
  

Record call details and customer interactions accurately in accordance with departmental standards and compliance requirements.

• Collaboration & Teamwork:
  
  

Work collaboratively with peers and cross-functional teams to resolve issues, contribute to shared goals, and foster a positive team environment.

• Performance Goals:
  
  

Consistently meet or exceed departmental goals related to quality, productivity, customer satisfaction, and compliance.

• Flexibility:
  
  

Support the department by performing additional duties as needed, demonstrating reliability and adaptability.

What We’re Looking For

• Professional Experience:
• Prior work experience in a customer-facing position. Demonstrated career progression preferred.
• A minimum of three consecutive years in a previous role.
• Technical Competency Assessment: The completion of a 60–90 minute competency assessment is a required step in our hiring process. This assessment must be completed on a laptop or desktop computer. It cannot be completed on a mobile device
• References: Outstanding professional references from prior supervisors.
• Background Check: Successful candidates will be required to satisfactorily complete a pre-employment background check. This includes a criminal history check as well as verification of education and last 3 employers.
• Remote Workspace:
  

WellSense remote employees are required to have a quiet, distraction-free, private, and secure workspace.

• WellSense Health Plan is hiring in the following states: Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin
  
  

Qualifications

Education:

• High school diploma or equivalent required, bachelor’s degree preferred
  
  

Experience

• Prior professional work experience, ideally with customer service
  
  

Competencies, Skills, And Attributes

• Outstanding customer service skills
• Excellent verbal and written communication skills
• Strong organizational skills with the ability to prioritize a high volume of adjustment requests, multi-task and prioritize work
• Ability to make reasonable and sound business decisions based on established standards and guidelines
• Working knowledge of Microsoft Office products
• Bilingual in Spanish, Portuguese, Haitian Creole or other language is highly desirable
• Able to comfortably work from home with access to a high-speed internet connection
• Regular and reliable attendance
• Ability to work overtime during peak periods
  
  

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees

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