Medicare Advantage Customer Service Team Lead

Site: Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Responsible for providing exceptional customer service to Medicare beneficiaries by handling inquiries, resolving concerns, and offering guidance on benefits, claims, billing, and enrollment. This role supports patients and members within a healthcare organization through phone-based, email, and in-person interactions, and plays a key role in ensuring a positive member experience.

Essential Functions

-Respond to inbound calls, emails, and inquiries from Medicare members, family members, and caregivers regarding coverage, eligibility, claims, and billing.

-Assist members in understanding their Medicare plan benefits and how to access services within the healthcare network.

-Document all member interactions accurately in customer service or call center systems.

-Collaborate with departments such as billing, care management, and clinical teams to resolve complex member issues or escalations.

-Educate members on preventive services, appointment scheduling, and care navigation resources.

-Follow scripts, protocols, and compliance guidelines in accordance with Medicare and CMS regulations.

-Maintain confidentiality and protect patient/member information per HIPAA guidelines.

-Identify recurring concerns or patterns and escalate trends to leadership to improve processes.

-Meet performance and quality metrics such as call volume, response time, and customer satisfaction scores.

Qualifications

Education

High School Diploma or Equivalent required and Associate's Degree Healthcare Administration preferred or Associate's Degree Business preferred or Associate's Degree Related Field of Study preferred

Experience

- Experience in Customer Service, preferably in a healthcare, insurance, or call center setting 1-2 years required

- Experience working with Medicare beneficiaries, healthcare billing, or insurance plans 0-1 year preferred or Experience with CRM, call center software, or electronic health records (EHR) systems 0-1 year preferred

- Experience working with DSNP preferred

Knowledge, Skills and Abilities

- Strong understanding of Medicare benefits, claims processes, and CMS guidelines.

- Excellent verbal and written communication skills.

- Ability to remain calm and empathetic when dealing with frustrated or confused members.

- Strong attention to detail, accuracy, and documentation.

- Ability to multitask in a high-volume, fast-paced call center environment.

- Proficient in Microsoft Office and call tracking software.

Additional Job Details (if applicable)

• M-F 8:30AM - 5PM EST business hours required for remote role
• A quiet, secure, stable, HIPPA-compliant workstation is required.

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Evening (United States of America)

Pay Range

$22.22 - $31.71/Hourly

Grade

4At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.