Customer Service Professional (Remote)

• Serve as the primary liaison for members and providers for all lines of business including MassHealth, and Commercial members regarding general program inquires such as eligibility verifications, authorizations, referrals, claims, material fulfillment, address changes and Primary Care Physician assignments as well as member related policy and procedures.
• The CSP must be able to handle and demonstrate skills in handling benefits, claims and eligibility calls for the member and provider population.
• Identify customer issues/concerns rapidly and precisely
• Research required information using available resources and triage when necessary
• Handle and resolve customer inquiries and complaints, exhausting all efforts within the CSP’s scope before requesting assistance
• Identify and escalate priority issues in order to create efficiencies
• Initiate follow up customer calls where necessary
• Complete call logs to record customer interactions and transactions, recording details of inquiries, complaints, and comments, as well as actions taken
• Refer customer grievances and appeals to designated departments for further investigation
• Responsible for navigating multiple systems in order to resolve customer issues
• Act as the primary representative for Allways for our customers focusing on first call resolution and customer engagement.
• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.
• Maintain Customer Service Behavior Competencies
• Communication
• Flexibility/Adaptability/Willingness/Team Player/ Positive Attitude
• Relationship Building/Caring
• Service Excellence/Accountability/Critical Thinking

• High School Diploma or equivalent
• 4+ years in customer service environment
• Knowledge of customer service principles and practices
• Ability to resolve customers' problems and to demonstrate patience and remain courteous when faced with difficult or angry callers
• Ability to work well under pressure and in a rapidly changing environment

• Associates Degree or Bachelor’s Degree
• High school and college level courses in computers, English, or business helpful
• Bilingual (Spanish) or other
• 2+ years in an HMO/Health Care Industry setting
• Knowledge of call center telephony and technology
• Proficiency with MS Office suite
• Understanding of Protected Health Information (PHI) and the necessity to maintain confidentiality of this information
• Understanding of or training in Medical terminology
• Understanding of medical coding is helpful

NHP offers competitive salaries and an excellent flexible benefits package that includes medical, dental and vision insurance, paid time off, commuter benefit, and a generous employer contributed retirement program.

Allways' mission targets a diverse population and our employees are just as diverse. As an equal opportunity employer, NHP recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.