Call Center Benefits Representative
The primary goal of the Member Advocate is to conduct phone outreach to members in order to establish eligibility for Social Security benefits (SSI/SSDI) or MassHealth disability benefits. Works in close collaboration with members and MCO plan to identify potential qualifying circumstances to enroll the members into disability entitlement programs. Interviews members to understand the implications and complexities of their medical situation and its impact on their ability to function. Acts as a liaison between members, Social Security Administration and/or MassHealth to ensure application is processed promptly and effectively. Determines eligibility, assists in completion of appropriate applications, and serves as an advocate. Responsibilities include, but are not limited to:
- Educate members and his/her family on various social security programs and the importance of utilizing the programs.
- Identify appropriate social security entitlement programs for members and facilitates enrollment when needed. Helps members identify and obtain necessary resources.
- Screen members via phone to determine eligibility. High volume outreach efforts.
- Interact with members, MCO plans, attorneys, physicians and family members directly either orally or in written correspondence to acquire necessary information to complete the application process.
- Document cases including assessment and member's consent to obtain assistance and release forms.
- Inform members of documentation required to process application, required time frames, potential entitlement information and status either by phone and/or written correspondence.
- Document members’ interactions, process status and telephone conversations appropriately in our proprietary database system.
- Manage referral case load in accordance with company guidelines.
- Advocate on a case, policy and program level by understanding individual needs.
- Demonstrate receptive, empathetic, and sensitive attitudes while valuing cultural diversity.
- Respond to various written and telephone inquiries including eligibility, approval/denial determinations, status and continuation or closure of benefits.
- Provide linkage with appropriate community and government resources by maintaining knowledge of other systems, making referrals and identifying other unmet needs.
- Respond to customer service issues within required time frames to meet customer expectations.
- Achieve productivity standards and goals set by the company while maintaining high levels of customer service.
- Support HFI initiatives to maximize revenue for our healthcare clients by advocating for their most vulnerable members.
- Participate in Department and HFI Committees and Projects as assigned by the SS Operations Manager.
- Other duties may be assigned.
- Associates Degree in related field or equivalent combination of education and experience, required.
- At least 3 years of call center experience, handling inbound and outbound calls.
- Ability to handle high call volumes and work on the phone for extended periods of time.
- Excellent phone manner.
- Ability to meet deadlines while balancing competing demands and performance benchmarks.
- Ability to multitask and managed detailed information.
- Bilingual (English/Spanish/Portuguese/Vietnamese/Chinese/Russian), a plus.
- Strong analytical and decision-making skills.
- Self-motivated, responsible, and accountable. Identifies own learning needs and seeks appropriate assistance.
- Ability to adjust to rapid change in a client-service-oriented environment.
- Positive mentality and the ability to exhibit flexibility in times of change.
- Strong emotional strength and maturity to deal effectively with a challenging and vulnerable population.
- Ability to effectively interface with diverse and culturally different populations.
- Superior organizational, time management and project management skills.
- Excellent computer skills including: MS Office.
- Ability to sit for the majority of the shift.
- Ability to work well within a fast-paced, team-oriented environment.
- Ability to function independently; have flexibility and personal integrity.
- Work Schedule: Full-Time Hours (40 hrs/week Monday - Friday with the option to work either a 9-5 or 12-8 pm shift.
HFI is strongly committed to diversity and inclusion. We recognize the rich variety of backgrounds, experiences and points of view of a diverse staff that enhances both the quality of the services we provide and the excitement and innovative spirit of our work culture.
We are committed to a policy of non-discrimination and equal employment opportunity for all employees and qualified applicants without
regard to race, color, religious creed, national origin, ancestry, sex, age, disability, veteran’s status, sexual orientation and/or genetic information.
12pm - 8pm Eastern Time
40 hours a week
Job Status: On Call