Job Details

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 person 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

What You'll Bring

• Exceptional Customer Service Skills and exceptional communication abilities
• High School Diploma or Equivalent required
• Associate's Degree Healthcare Management preferred
  

What You'll Do

• Serve 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
• Handle 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
• Act 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.
• Maintain Customer Service Behavior Competencies
• Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
• Relationship Building/Caring
• Service Excellence/Accountability/Critical Thinking

Working Model

This role is 100% Remote (including training), a quiet, secure, stable, HIPPA compliant workstation is required to work from home in the United States, Eastern Business hours required

• 10/20/25 Start Date
• 1 Month Training schedule: 8:30 AM - 5:00 PM Mon - Fri EST.
• Post Training Schedule:
  • 9:00 AM - 5:30 PM (Mon, Tue, Wed, and Fri) with 11:30 AM - 8:00 PM (Thurs) (EST)
  • 9:30 AM - 6:00 PM (Monday-Friday) (EST)

• You will train together with other new CSPs
• Our Team is growing and we have over 10 spots open for our October start date!
• Our team works from home across many states, a growing remote team stays connected weekly and daily with Video meetings

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.