About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.
Brief summary of purpose:
Manage Customer Services team. Respond to customer inquiries for information and requests for service associated with the resolution of provider complaints, claim processing, appeals and grievance issues and various operational concerns. Interpret Fallon policies and facilitate the research required to resolve customer issues.
Monitor work of individual staff for efficiency, effectiveness and quality. Provide ongoing constructive feedback and guidance to team.
Acts as a senior resource person/subject matter expert for team members in all areas of the work, including but not limited to: application of appropriate policy and procedures, etc.
BA or BS in related discipline or equivalent combination of training and experience.
Minimum of 2 years of experience in a customer service role for a healthcare services environment. Minimum 2 years of supervisory experience preferred.