Customer Service Representative

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Act as the main point of contact and intermediary for members, providers, and key stakeholders.

• Offer information and resolve complex inquiries regarding coverage, benefits, services, eligibility, authorizations, referrals, claims, material fulfillment, address changes, and primary care physician assignments.

• Address and resolve customer inquiries and complaints, utilizing all available resolution options within the designated scope.

• Quickly and accurately identify customer issues and concerns.

• Research information using available resources and triage when necessary.

• Recognize and escalate priority issues.

• Initiate follow-up calls to customers when required.

• Maintain call logs documenting interactions, inquiries, complaints, comments, and actions taken.

• Refer customer grievances and appeals to the appropriate departments.

• Navigate various systems to address customer issues.

• Achieve first-call resolution and enhance customer engagement and satisfaction.

• Transition from member demographic and benefits training to claims and provider claims inquiries as competencies and business requirements evolve.

⛳️ Requirements

• High School Diploma or Equivalent is mandatory.

• An Associate's Degree in a related field or Healthcare Management is preferred.

• Outstanding customer service skills are essential.

• Clear, concise, compliant, personable, and professional verbal and written communication abilities.

• Capacity to multitask and prioritize effectively.

• Call Center experience is a plus.

• Capability to manage benefits, claims, and eligibility inquiries for both member and provider populations.

• Flexibility, adaptability, willingness, and a team-oriented mindset are necessary.

• A positive attitude is vital.

• Skills in relationship building and providing caring service.

• Commitment to service excellence, accountability, and critical thinking.

• Availability to work Monday through Friday during EST hours.

• A quiet, secure, stable, and compliant workstation must be available from within the US.

• Proficiency in using MGB-provided equipment and participation in video calls during the work week is required.

🏝️ Benefits

• MGB-provided equipment.

• Comprehensive benefits package.

• Opportunities for career advancement.

• Differentials, premiums, and bonuses as applicable.

• Recognition programs.

• Support for professional growth.

• Reasonable accommodations for applicants with disabilities.