Fantastic Call Center & Advancement Opportunities in Health Care!
The Opportunity:
We are currently hiring for a 9:30 am - 6:00 pm shift with one evening per month and occasional weekends between October - February.
It’s an exciting time to join Fallon Health as we experience growth and expansion with new services and products. There are many great opportunities within our organization starting with joining our Member Services team. Member Services offers a very unique opportunity to interact with nearly every facet of the FCHP organization including our products, services, functions, and people.
Among the most rewarding and fulfilling parts of working on this team is representing Fallon Health as the face of the organization; the single point of contact for our valued providers and members. Think of yourself as an FCHP brand and membership ambassador. As a representative of Fallon Health, you will be an advocate to members reaching out for support; providing this highly valued service fielding calls and consultatively troubleshooting inquiries, you will be solving their needs and concerns.
In addition to the diverse responsibilities outlined below, a spot on this team also represents one of the best places to grow your career. With demonstrated initiative and strong performance, you will gain exposure across a multitude of functions and endless opportunities for advancement. Member Services has proven to be a launching pad of development that has translated into long term careers with advancement opportunities throughout the company in a number of different key area’s such as; Sales and Marketing, Provider Relations, Care Services, Pharmacy and other functions of the operation.
As a brand champion and valued member ambassador you will get extensive training and support through a skill based progression training program that includes a blended learning curriculum and personalized coaching plan. We are always looking for top talent in these roles so feel free to pass this along to friends, family and colleagues that you think qualify.
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.
Summary:
The Manager of Member Appeals & Grievances is responsible for the oversight of the daily operational management of member appeals coordinators, which can include the Commercial, Government, and Triage Units. In addition to the oversight of direct reports, the Manager is responsible for all activities related to:
- Managing the appeals procedures and ensuring that appeals are resolved appropriately and that members are granted their rights, specifically to appeal non-coverage decisions made by the health plan.
- Ensure that pertinent data regarding member grievances and appeals is captured and entered into the appropriate IT application, in compliance with the health plan, governmental and accrediting agency requirements.
- Orient and train team members and ensure adequate staffing to handle volume of member calls and meet the performance metrics for the department.
Fallon Health Weinberg is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg offers a Program of All-Inclusive Care for the Elderly (PACE) and a Managed Long Term Care (MLTC) plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high-quality, affordable health care.
Founded in 1977, Fallon Health provides health care services designed to meet the unique and changing needs of all they serve. It consistently ranks as one of the nation's highest-rated health plans, according to the National Committee for Quality Assurance (NCQA).* Fallon Health coordinates care with its Senior Care Options/Special Needs Plan for dual-eligible people who are 65 and older. Fallon Health has operated a PACE program in Massachusetts for more than 20 years and is the largest PACE program in New England and sixth largest nationally.**
Weinberg Campus has been providing needed services to the elderly for more than 100 years, through both community-based programs and nursing facility care. It is a renowned geriatric education and training institution offering the widest range of housing and care options available on one campus.
The two parent companies, Fallon Health and Weinberg Campus, have demonstrated consistent commitment to providing an array of solutions that make high-quality, integrated and affordable care more accessible to the poor, disabled and senior populations within the communities they serve.
To provide the members of the managed long term care plan with assistance as needed with benefits, authorizations, and communications.