Customer Care Center Representative

Overview: With a long-standing commitment to identify needs and remove barriers to affordable, accessible health care, Neighborhood Health Plan (NHP) provides health care programs and related services to individuals receiving benefits under Medicaid, through small business employer groups, and through the state's ground-breaking new health care reform initiative. NHP currently has an opening for a Customer Care Representative I. Responsible for serving NHP members and providers in a high volume, fast paced call center environment while providing high quality customer service. Responsibilities: • Serve as the primary liaison for all members, providers and prospective members regarding benefits, claims resolution, pharmacy issues, eligibility, material fulfillment, premium rates, provider contracting, policies and procedures.• Responsible for navigating multiple systems in order to resolve member and provider issues.• Responsible for understanding the distinction between various lines of business (MassHealth, Commercial and Non-Group) and reimbursements specific to each, as applicable.• Initiate review and resolution of all pharmacy, complex billing and member appeals issues.• Reprocess non-complex incorrectly processed claims at the time of calls and coordinating complex claims resolution with Claims Services.• Track individual service levels and quality results against department goals.• Accurately log all member and provider inquiries into eligibility database.• Update all PCP and group demographic changes.• Perform Welcome Calls or surveys as required for new members.• Generate customer correspondence.• Process returned mail. Qualifications: • High School; Associates Degree preferred• 1 to 2 years in an HMO call center or equivalent environment preferred. • Bilingual,Spanish or other• Type 25 wpm, excellent written and verbal communication skills, strong computer skills, positive thinker and ability to multi-task, prioritize and work within a team setting.• Knowledge of Medical Terminology or Claims & Billing a plus. NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, generous earned time, commuter benefit, and a 401(k) employer contributed retirement program. To apply, please visit our website: www.nhp.org NHP is an Equal Opportunity Employer. Apply for this job online What makes Neighborhood Health Plan such a special place? Our team! We are a group of over 300 people who are committed to working together to achieve the NHP mission of providing member-focused, quality driven health care for people of low income, on public health insurance or with chronic illness or disability. With one of the most diverse workplaces in the greater Boston area, a great location within walking distance of South Station, Neighborhood Health Plan is a great place to work!