Harvard Pilgrim Health Care
Medicare Advantage Rep
July 2015 — Present
• Receives and responds to a high volume of incoming calls. Provides accurate and thorough information relative to HPHC Medicare Advantage benefits, eligibility and enrollment policies to members, brokers, providers and internal customers. May also respond to customer and broker inquiries made through written format.
• Answers complex product billing, enrollment, claims and eligibility questions
• Understands and relays information and resolves issues regarding contract riders, member programs and all HPHC vendor relationships.
• Captures and documents customer feedback; receives, resolves, and routes complaints as defined by Department, Corporate and Regulatory policies, procedures, and guidelines.
• Accurately handles appeals process inquiries. Consults with appropriate staff from all levels within the department well as with Appeals to effectively address a member’s inquiry.
• Protects member privacy and confidentiality by consistently maintaining full compliance with all HIPAA regulations. Verifies member information and validates appropriateness of broker contacts in order to handle broker inquiries via telephone and in written format provided there is appropriate authorization on file if the broker is requesting member information.
• Maintains thorough understanding of HPHC’s policies, products and systems.
• Manages time appropriately to maximize availability to assist customers.
• Other duties and projects as assigned.