Team Lead, Member Services

Job SummaryUnder the general direction of Call Center Member Support Supervisor, the Member Services Team Lead is responsible for accurately and thoroughly interpreting THP Medicare Preferred benefits, claims processes, eligibility, and enrollment policies to assist Help Desk, member and provider reps with calls from members, providers, pharmacies and internal customers. In addition, the Member Services Team Lead is responsible for assisting Customer Relations Help Desk Representatives with resolution of complex inquiries and facilitation of problem resolution. The Member Services Team Lead is expected to act as a resource/educator and to serve as a role model to other customer service representatives. Must be flexible in regard to scheduling. Requires ability to adapt positively to changes related to work processes, department structure, environment and technology. Key Responsibilities/Duties - what you will be doingKEY RESPONSIBILITIES/ESSENTIAL FUNCTIONSResponds professionally and promptly to phone inquiries while maintaining the required performance service standards:Answer incoming phone calls from internal customers including member service reps, provider service reps and other departments. Adheres to department customer service expectations.Ensures issues are accurately and completely resolved by using available electronic resources including THPMP's on-line reference tools and, external website as well as consulting members of the leadership team and internal contacts in other key departments.Educate callers and reps to avoid unnecessary repeat calls and delays.Adheres to assigned schedules to ensure appropriate phone coverage.Achieves individual performance expectations to contribute to the cost-effective delivery of high quality service. Strives to meet or exceed the department's established service standards.Serves as an expert with regard to member and claim knowledge and THP MP Systems.Performs QC of reviewed legal documents.Review scored calls for potential disputes.Perform side-by-side evaluations.Assign work to the Help Desk reps from both the Help Desk MACESS and IBM Notes boxes.Track educations identified by the Help Desk and inform appropriate supervisor/Team Lead.Responds to e-mail and actiongram inquiries from other key departments in a timely manner when necessary.Clearly and accurately documents all issues, resolution steps and follow up actions.Special projects as assigned.Adheres to Tufts Health Plan's Corporate Compliance policy.Act as covering supervisor a minimum of one night per week and at other points as needed.Answer Help Desk calls and Escalations during 3 hours of scheduled queue time per day and at other points as needed for back up. Qualifications - what you need to perform the jobEDUCATION: (Minimum educations & certifications required)High School Diploma/GED or equivalent relevant work experience is required. EXPERIENCE: (Years of experience)A minimum of 1 year experience within the THPMP call center or other internal department working with senior products is required.SKILL REQUIREMENTS: (Include interpersonal skills)Proficiency with MS Windows and proficient keyboard skills. Strong verbal and written communication and organizational skills required as well as the ability to research and respond to a high volume of telephone, electronic and mail inquiries in a consistent and professional manner. Basic math, grammar, and spelling are required. Knowledge of medical terminology is a plus.Must be able to balance working both independently as well as collaboratively with the team.WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel, overtime)Fast paced office environment handling multiple demands. Open cubicle work setting with a personal computer. Schedule rotation involving evening and weekends.Involves simultaneous use of a telephone headset, and PC/keyboard for long periods of time in order to document and communicate efficiently along with long periods of sitting.Occasional overtime may be requested.CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Will be exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy and department guidelines/policies and all applicable laws and regulations at all timesCompensation & Total Rewards OverviewAs part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:Medical, dental and vision coverageRetirement plansPaid time offEmployer-paid life and disability insurance with additional buy-up coverage optionsTuition programWell-being benefitsFull suite of benefits to support career development, individual & family health, and financial healthFor more details on our total rewards programs, visit to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health EquityPoint32Health is committed to making diversity, equity, and inclusion part of everything we do"”from product design to the workforce driving that innovation. Our DEI strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Who We ArePoint32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.We enjoy the important work we do every day in service to our members, partners, colleagues and communities.Scam alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@.This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law.Req ID: R8296

Created: 2024-11-07