Member Services Representative Part
CCA 198 reviews - Boston, MA

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Must Be Bilingual: Spanish, Vietnamese, Portuguese and/or Cape Verde Creole

Organization Overview:

Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.

Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.

Position Summary:

To provide a single point of contact for questions, problem solving, and access to care, for all involved in CCA members’ care, including the Senior Care Options (SCO) and Integrated Care Organization (ICO) Programs. To provide accurate, prompt, and courteous service in response to written and telephonic inquiries, from Members, Members’ Care-Givers, Primary or Interdisciplinary Care Team Members, Pharmacies, and Vendors. To facilitate quality member care and service delivery by responding to every inquiry immediately and directly, when possible, or by collaborating with our Interdisciplinary or Primary Care Teams, Clinical Staff, and others involved in providing care for our members.

Hours for this position:

Saturday & Sunday (8:00 a.m. – 6:00 p.m.)
Monday, Wednesday & Friday (4:00 – 8:00 p.m.)


· Respond to, and answer all member and provider inquiries in a courteous, responsive, comprehensive, effective, and accurate manner following all departmental and organizational policies and procedures.
· Participate as part of a team conducting and/or supporting outreach to members regarding benefits and eligibility requirements.
· Thoroughly document all member related and prospective member interactions into CCA database for purpose of accurate tracking and analysis.
· Coordinate with various roles within CCA and its interdisciplinary and/or primary care partners to ensure external and internal customer requests and questions are handled appropriately and in a timely manner.
· Access and understand all related education resource material in order to respond to a member’s questions and concerns accurately and appropriately.
· Provide direct member education about benefits in an ongoing, proactive manner.
· Process members’ grievances and appeals in accordance with CCA policies.
· Process members’ disenrollment from CCA in accordance with CCA policies.
· Use computerized systems for tracking, information gathering, and troubleshooting.
· Offer recommendations for improvements in Call Center and CCA procedures to enhance service delivery and customer satisfaction.
· Provide translation and interpretation when requested/approved by supervisor.
· Take responsibility for one or more administrative functions or special projects of the Member Services Department.
· Daily tasks include: ongoing incoming and outgoing phone calls; ongoing incoming and outgoing email; ongoing use of member database and members’ electronic medical records; processing paper mail; and processing faxes.
· Provide other duties as assigned.


· Bachelor’s Degree preferred (Associate’s Degree+ required)
· Fluency in oral and written English required
· Fluency in at least one other language strongly preferred and may be required depending on departmental need– prefer Spanish, Vietnamese, Portuguese and/or Cape Verde Creole.
· Experience and competency working with a diverse disabled population
· Must have experience providing customer-focused service/activities; experience answering multiple calls at one time and managing large amounts of email; experience independently problem-solving by referencing information and policies; and experience with data entry and using Microsoft Office software.
· Knowledge of Massachusetts’ health care delivery system/services;
· Prior experience working in medical setting;
· Prior experience working in a Call Center;
· Ability to complete mail merge;
· Experience using and entering data into electronic medical records.
· Must have experience working in a diverse environment: colleagues, members and providers are diverse socioeconomically, ethnically, and culturally.
· Must possess exceptional oral and written communication skills, including the ability to manage difficult callers and conflict.
· Must be flexible and comfortable working in an environment that includes continual change for quality improvement.
· Must have the ability to: develop a thorough knowledge of benefits, related payment policies, and medical terminology; work independently as well as within a team environment; prioritize work; and manage and track outstanding work and work due in the future.

Physical Abilities:

The MSR position requires the ability to sit at a desk, while talking on the telephone and using the computer, for eight hours each day. The position requires the ability to focus on own work while sitting at a desk cubicle in a Call Center. The position also requires light lifting and bending, while filing member records and similar. The position might require occasional travel to contracted provider sites.

About this company
198 reviews