Top 2391 Member services representative Jobs in Middleton Ma

SCO Care Navigator - Lawrence - Khmer preferred
Fallon Health —Lawrence, MA
- $28 - $30 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Bachelor of Science
Crew Member - PAID TRAINING
Goldfish Swim School - Danvers —Danvers, MA
- $17.25 - $21.00 an hour
- Part-time
- Background check
- 16+ years old
- Teaching
- Paid training
- Parental leave
Quick Apply
Assistant Program Director
NFI Massachusetts, Inc. —Peabody, MA
- $70,000 a year
- Management
- Mid-level
- Residential
- 403(b) matching
- Paid holidays
Quick Apply
HR Consultant II (Part Time or Full Time)
Insource Services —Boston, MA
- $100,000 - $140,000 a year
- Part-time
- Hybrid work
- 5 years
- Mid-level
- Presentation skills
- Disability insurance
- Dental insurance
Quick Apply
Call Center Representative
Atlantic Group —Reading, MA
- $22 - $23 an hour
- Contract
- Microsoft Excel
- Microsoft Outlook
- Writing skills
- Health insurance
- Dental insurance
Quick Apply
4d
Member Services Representative
Fitness Holdings - Crunch Fitness —Danvers, MA
- Part-time
- Communication skills
- Entry level
- Employee discount
- Opportunities for advancement
Quick Apply
Administrator's Assistant
Greater Lawrence Technical School (MA) —Andover, MA
- $62,408 - $87,927 a year
- Full-time
- Bilingual
- School experience
- Google Workspace
Executive Assistant
Andover Public Schools —Andover, MA
- $30.93 - $41.12 an hour
- Full-time
- High school
- Mid-level
- Office
11d
Front Desk/Call Center Representative
Andover Eye Associates Inc —Andover, MA
- $21 - $27 an hour
- Anatomy knowledge
- Basic math
- Organizational skills
- Health insurance
- Dental insurance
Quick Apply
Patient Care Representative
42 North Dental —Beverly, MA
- $20 - $25 an hour
- Dental office
- HIPAA
- Entry level
Quick Apply
Premium Guest Services Representative Part Time
American Airlines —Boston, MA
- From $20.23 an hour
- Extended hours
- Sales
- High school diploma or GED
- Criminal background check
- Health insurance
- Dental insurance
21h
Educational Team Facilitator
Andover Public Schools —Andover, MA
- Part-time
- Experience working with individuals with disabilities
- Computer literacy
- Teaching Certification
Patient Access Representative – 24 hrs; Sat & Sun 6:30am-7pm
Beth Israel Lahey Health —Peabody, MA
- $20.50 - $27.59 an hour
- 12 hour shift
- Bilingual
- Microsoft Excel
- Microsoft Outlook
1d
Welcome Express Guest Services Representative
Northern Essex Community College —Haverhill, MA
- $4,098.06 - $5,712.26 a month
- Full-time
- Background check
- Spanish
- Office
- Disability insurance
- Health insurance
Customer Care Specialist II
Saia Motor Freight Line LLC —North Reading, MA
- $23.10 - $28.15 an hour
- Full-time
- 18 years or older
- English
- Mid-level
Quick Apply
8d
Human Resources Assistant
Beverly Public Schools —Beverly, MA
- Full-time
- Bilingual
- Background check
- Google Workspace
- Loan forgiveness
Quick Apply
14d
Spa Receptionist
Encore Boston Harbor —Everett, MA
- $22 - $24 an hour
- Part-time
- 18 years or older
- Computer literacy
- Basic math
Quick Apply
PAS Registration Coordinator
North Shore Medical Center, Inc. —Salem, MA
- $19.81 - $28.30 an hour
- Part-time
- Hospital
- Customer service
- Medical office experience
- Opportunities for advancement
Quick Apply
8d
IT Support Representative (Local Candidates Preferred)
LinQ Global Group —Boston, MA
- Call employer
- Remote
- Bilingual
- Children
- Organizational skills
Special Education Paraeducator (LIFT Program) (56 hours biweekly)
Reading Public Schools —Reading, MA
- $25.38 - $32.43 an hour
- Full-time
- Classroom
- CPR Certification
- High school diploma or GED

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member services representative jobs near middleton ma

SCO Care Navigator - Lawrence - Khmer preferred

Fallon Health -
Lawrence, MA

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Job Details

Full-time
$28 - $30 an hour

Qualifications

Microsoft Excel
Microsoft Outlook
Driver's License
Driving
Motivational interviewing
Working with individuals from diverse cultural backgrounds
Experience working with individuals from underserved communities
Experience working with individuals with language barriers
Medical terminology
Home visits (communication methods)

Full Job Description

Overview:

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose:

The Navigator–Care Management is part of an interdisciplinary care team that coordinates care, improves access, and supports quality outcomes for NaviCare members. The Navigator builds relationships with members/caregivers via phone and in person, conducts home visits as needed, helps implement care plan interventions, and works to remove barriers to care. In partnership with the Nurse Case Manager, the Navigator updates care plans and provides holistic case management for low-, moderate-, and high-risk members.

Responsibilities:

Primary Job Responsibilities

Member Education, Advocacy, and Care Coordination

Conduct phone and, as appropriate, in-person assessments, screenings, and visits using TruCare; update individualized care plans and aim for first-contact resolution in a culturally responsive manner.
Coordinate and follow up on care needs, including post-transition outreach, appointment scheduling, medication support, and service monitoring.
Educate members/representatives on benefits, coverage criteria, rights, appeals, authorizations, and evidence of coverage.
Identify and address gaps in care (e.g., PCP assignment, preventive screenings, vaccinations) per established protocols.
Screen for social determinants of health and refer to community resources (e.g., food, housing, fuel assistance, transportation); escalate clinical decisions to the Nurse Case Manager or PCP.
Advocate for members’ access to covered benefits and coordinate with community agencies for non-covered supports.

Provider Partnerships and Collaboration

Participate in—and as appropriate, lead—care plan meetings with providers, partners, and care team members.
Collaborate with the interdisciplinary team (e.g., LTC, behavioral health, advanced practitioners, community partners) to support coordinated care.
Build effective working relationships with community partners and providers (e.g., housing, ADH, assisted living, LTC facilities, PCPs) to support timely, member-specific communication.

Access to Care

Submit and track requests/authorizations for covered services; ensure accuracy and timeliness per program workflows.
Educate members and providers on authorization processes and help resolve authorization issues.
Facilitate access to medical, behavioral health, and social services, including arranging transportation when needed.

Care Team Communication

Communicate timely updates with members, caregivers, providers, and internal teams on care plans, service changes, and member status.
Partner with LTC and community teams during admissions, transitions, and discharges to ensure continuity of care.

Regulatory Requirements, Documentation, and Reporting

Complete required activities to meet CMS/State, NCQA, HEDIS, and other standards (e.g., welcome calls, screenings, care plans).
Document accurately and on time in TruCare and related systems; review and validate member panel data and reports.

Additional Responsibilities

Maintain knowledge of program benefits, policies, procedures, and community resources.
Support operations by covering assignments, adapting to priorities, and completing other duties as assigned.
Mentor or train staff on job-related processes and workflows, as assigned.

Qualifications:

Education

College degree (BA/BS in Health Services or Social Work) preferred

License/Certifications

License: N/A

Certification: Community Health Worker - preferred

Other: Satisfactory Criminal Offender Record Information (CORI) results

Driving your personal motor vehicle is an essential job function of this position and the following requirements apply:

Must possess a valid drivers’ license
Must attest to no disqualifiers per Driver Safety Policy
Must possess and provide proof of minimal state required auto insurance
Must have reliable transportation

Education

2+ years’ experience in managed care and/or community-based health and human services (e.g., home health, personal care management, independent living, ASAP, or relevant state agencies) preferred
Understanding of hospitalization and post-discharge needs required
Working knowledge of medical terminology, common conditions, and medical record documentation; able to identify triggers requiring RN intervention required
Motivational interviewing experience and ability to work effectively with diverse and non-English-speaking populations required
Understanding of social determinants of health required
Proficiency with Microsoft Office (Excel, Outlook, Word) required
Experience with face-to-face member visits and working with providers/community partners preferred
Experience working on a multidisciplinary care team within a managed care organization preferred

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is $28/hr - $30/hr which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

#P01

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Refine Your Search

member services representative jobs in middleton ma

SCO Care Navigator - Lawrence - Khmer preferred

Crew Member - PAID TRAINING

Assistant Program Director

HR Consultant II (Part Time or Full Time)

Call Center Representative

Member Services Representative

Administrator's Assistant

Executive Assistant

Front Desk/Call Center Representative

Patient Care Representative

Premium Guest Services Representative Part Time

Educational Team Facilitator

Patient Access Representative – 24 hrs; Sat & Sun 6:30am-7pm

Welcome Express Guest Services Representative

Customer Care Specialist II

Human Resources Assistant

Spa Receptionist

PAS Registration Coordinator

IT Support Representative (Local Candidates Preferred)

Special Education Paraeducator (LIFT Program) (56 hours biweekly)

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