Individual Member Specialist.(Medicare)

Harvard Pilgrim Health Care - Quincy, MA (30+ days ago)4.1


Are you interested in becoming part of a dynamic team that is looking to innovate and improve?
Would you like to work for a company that has been rated by the BBJ (15+yrs) as one of the best places to work?
Do you want to be part of a company that is committed to giving back to the community?

Harvard Pilgrim Health Care is currently seeking highly motivated individuals to join our organization as an Individual Member Specialist -Medicare to provide provide best-in-class service to all constituents of the Medicare Advantage program, including but not limited to members, individual members, brokers, employers, providers / pharmacists, vendors and internal Harvard Pilgrim staff, as a means to increase market membership, build customer loyalty, extend customer retention, and satisfy corporate goals and objectives. The Individual Member Specialist acts as a member and broker advocate by meeting or exceeding the customer’s expectations, while maintaining the interest of Harvard Pilgrim.

Receives and responds to a high volume of incoming calls. Provides accurate and thorough information relative to HPHC Medicare Advantage benefits, eligibility and enrollment policies to members, brokers, providers and internal customers. May also respond to customer and broker inquiries made through written format.
Answers complex product billing, enrollment, claims and eligibility questions
Understands and relays information and resolves issues regarding contract riders, member programs and all HPHC vendor relationships.
Captures and documents customer feedback; receives, resolves, and routes complaints as defined by Department, Corporate and Regulatory policies, procedures, and guidelines.
Accurately handles appeals process inquiries. Consults with appropriate staff from all levels within the department well as with Appeals to effectively address a member’s inquiry.
Protects member privacy and confidentiality by consistently maintaining full compliance with all HIPAA regulations. Verifies member information and validates appropriateness of broker contacts in order to handle broker inquiries via telephone and in written format provided there is appropriate authorization on file if the broker is requesting member information.
Maintains thorough understanding of HPHC’s policies, products and systems.
Manages time appropriately to maximize availability to assist customers.
Other duties and projects as assigned.


High school diploma and a minimum of 3years of customer service experience in a managed care environment or 1 year of customer service experience at HPHC are required, along with the successful completion of a comprehensive HPHC Member Services training program.
This position is within a call-center environment and compensates $20.20 (per hour.
There is an 8 – week paid training. No time may be taken off during the training. The training schedule will be Monday - Friday 8:30 to 5pm.
After training, schedule will be rotating Monday to Friday: 8:00am-4:30pm, 9:00am - 5:30pm and 11:30am - 8:00pm.
Saturday and Sunday rotating weekend/shifts are required from October 2018 thru March 2019.
Resilient, collaborative, flexible, innovative.

Paid volunteer time off (up to 3 days annually)
Annual Mini-Grant of $500 donated to a non-profit organization of the employee’s choice
Educational Reimbursement

Working Environment

Normal office environment.

Primary Location: United States of America-Massachusetts-Quincy