Member Outreach Representative - Fallon Health

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:

Under the direction of the Market Research Manager, supports Fallon by making Welcome/Outreach calls to members and/or survey calls to members or providers. Handles confidential patient/member information.  Uses strong verbal communication skills and demonstrates excellent telephone communication skills.  Understands the importance of leaving a positive impression on any member with whom they come into contact.  When necessary, assists member through the creation of formal research cases.

Responsibilities

Job Responsibilities:

• Exhibits courtesy, compassion, empathy, and respect in all outbound communications with members and providers. Utilizes proper judgment in handling difficult or unusual calls.
• Responsible for learning and keeping current with Fallon products, policies and procedures.
• Responsible for documenting the results of all outbound calls using an electronic or written form.
• Makes Welcome/Outreach telephone calls to Fallon members providing product knowledge, customer assistance, and problem solving.
• Administers member telephone surveys. Working from a script, asks both open-ended and closed ended questions of members in order to capture information such as why the member joined Fallon, how satisfied the member is with Fallon and why the member left Fallon. 
• Maintains the highest degree of member/patient confidentiality.
• Works both as a team member and as an individual depending on assigned project.
• Works on special projects and other tasks such as focus group recruitment and data entry as assigned by the Market Research Managers or executive staff.
• Assists Fallon members by creating formal research cases.  When necessary, is responsible for properly documenting member issues and entering information into a specialized company database.

Competencies:

• Adaptability – Handles day-to-day work challenges confidently. Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change.  Shows resilience in the face of constraints, frustrations or adversity.  Demonstrates flexibility
• Perseverance – Pursues everything with energy and drive and a need to finish. Seldom gives up before finishing, especially in the face of resistance or setbacks.
• Problem solving – Solves difficult problems with effective solutions. Asks good questions.  Can see underlying or hidden problems and patterns.  Is excellent at honest analysis.  Looks beyond the obvious.

Independent Action:

• Duties are generally procedural, allowing the individual to perform independently with intermittent supervision, in conformance with written instructions, established timeframes, and predetermined priorities. Problems not clearly defined by written directions or instructions are reviewed with Market Research Manager to determine course of action.

Qualifications

Education:

High School Diploma

License/Certifications:

N/A

Experience:

• Minimum of one year Customer Service experience in a call center environment
• Computer skills

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.

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