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Customer Service Associate

2 months ago


Canton, Massachusetts, United States Ignyte AI Full time
Job Overview

Position Summary:

The Member Services Representative, under the guidance of the Call Center Supervisor, plays a pivotal role in delivering precise and comprehensive explanations of Tufts Health Plan (Tufts HP) benefits, claims procedures, eligibility criteria, and enrollment guidelines to members, employers, and internal stakeholders. This role also involves addressing intricate customer inquiries, facilitating effective problem resolution, and striving to meet or surpass customer expectations.

Key Responsibilities:

  • Handle a substantial volume of incoming calls from members, potential members, employers, and internal staff.
  • Process member inquiries efficiently, which includes:
    • Utilizing the most suitable information sources to resolve member concerns proficiently.
    • Documenting interactions thoroughly while maintaining a professional demeanor.
    • Asking insightful questions to educate members and reduce repeat inquiries.
    • Investigating member complaints and conducting preliminary analysis and intervention as necessary.
    • Making outgoing calls to address member-related questions.
  • Achieve or exceed established performance metrics.
  • Adhere to scheduled shifts to ensure adequate coverage of phone lines.
  • Exhibit strong written and verbal communication skills.
  • Employ active listening, patience, and empathy to manage challenging customer interactions tactfully.
  • Seek opportunities to enhance efficiency in resolving member issues.
  • Collaborate with other departments to resolve issues effectively.
  • Engage in team initiatives and assist in mentoring new staff as directed.
  • Support departmental projects as required.

Qualifications:

Education:
High School Diploma or equivalent is required; an Associate's degree or relevant work experience is preferred.

Experience:
6-12 months of relevant experience is required, with a preference for customer service experience in healthcare, call centers, retail, hospitality, or corporate environments. Familiarity with medical terminology is advantageous. Experience in a virtual or remote setting is strongly preferred.

Skills:

  • Technical Skills: Proficient in multitasking with computers and telephones, navigating multiple systems, accurate data entry, and documentation, with a strong command of MS Windows and keyboarding skills.
  • Interpersonal Skills: Excellent verbal and written communication, strong organizational abilities, capacity to handle a high volume of inquiries consistently, basic math and grammar skills, and the ability to work under pressure while adapting to changing priorities. Team collaboration is essential, and bilingual skills are preferred.

Working Conditions:
This role operates in a fast-paced office environment that requires managing multiple demands while exercising sound judgment. A high level of initiative, independence, and effective communication skills are essential. Adaptability to changes in work processes, departmental structure, and technology is necessary. The position involves prolonged periods of sitting and may require occasional overtime and the ability to work from home.

Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity:
Point32Health is dedicated to integrating diversity, equity, inclusion, accessibility, and health equity into all aspects of our operations. Our DEIA and Health Equity strategies align with our core values and evolve with the changing nature of work. We encourage all qualified applicants to apply, and we are committed to providing equal employment opportunities without discrimination based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

About Us:
Point32Health is a prominent health and wellbeing organization focused on delivering personalized healthcare experiences to our communities. Building on the quality and nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, we leverage our expertise to help individuals achieve healthier living through a comprehensive range of health plans and tools.