Customer Experience Consultant in MassMutual's Worksite team, providing support for supplemental health operations. Conduct audits, handle claims inquiries, and optimize processes for improved service quality.
Responsibilities
Conduct target audits on invoices for supplemental health insurance policies; applied premium, outstanding and suspense payments, and billing discrepancies
Review and evaluate claims for Accident and Critical Illness products, ensuring compliance with policy terms, regulatory requirements, and state guidelines
Review and communicate process policy changes, updates, quotes, cancellations, and respond to client inquiries regarding policy details, coverage, and claims
Handle escalated inbound/outbound calls and emails regarding claims, billing, policy servicing, and portal issues
Provide exceptional customer service and troubleshoot customer inquiries
Document use cases, test scenarios, procedures, and decisions needed for operational readiness
Execute on testing and support User Acceptance Testing (UAT) for claims and billing processes
Navigate process and customer journey maps, translating insights into operational readiness and improvements
Develop, review, and maintain Standard Operating Procedures (SOPs) to ensure efficient and up-to-date processes
Curate and manage a central repository of playbooks, best practices, and resources to support day-to-day tasks
Work effectively across functional and organizational boundaries, collaborating with Business Analysts (BA), Product Owners (PO), Project Managers (PM), and other stakeholders
Take ownership of processes from billing to payment, including analysis of flows and requirements, and drive execution
Support integration of claims with external providers and manage add-on services
Review current customer service setup (call tree, talking points), analyze flows, and recommend improvements
Leverage experience with policy administration platforms, and Electronic Data Interchange (EDI)
Support and assist with Third Party Administrator (TPA) claims training, and review/co-sign TPA claims and billing refunds for accuracy and compliance
Assist in monitoring CSR performance to ensure service standards are met
Requirements
5+ years of Insurance Industry experience and/or supplemental or group health insurance operations, claims backend, billing, and policy servicing
Experience in customer service, claims adjudication, billing, and policy administration
Exposure to technical platforms (EIS, EDI) and process improvement initiatives
Experience supporting TPA operations and training
Experience in documenting use cases, test cases, procedures, and decisions; ability to analyze and translate process maps into actionable steps
Ability to navigate and interpret process and customer journey maps
Proven ability to work in a matrix environment, manage execution, and collaborate across functions (BA, PO, PM, etc.)
Comfortable taking on E2E responsibility and driving results
Experience working in Agile environments
Exposure to quoting, product setup, and enrollment processes in addition to servicing
Experience with EIS or similar platforms; familiarity with EDI
Experience working with TPAs and understanding their processes
Strong communication and interpersonal skills; ability to review and optimize customer service flows
Experience in monitoring and improving team performance
Ability to develop SOPs and conduct UAT for claims and billing
Proficiency in MS Excel and reporting tools
Understanding of HIPAA, ERISA, and state regulations
High level of accuracy and attention to detail
Strong critical thinking and decision-making skills
Ability to work under pressure, meet deadlines, and adapt to changing priorities
Benefits
Regular meetings with the Worksite Supplemental Health Operations Team
Focused one-on-one meetings with your manager
Networking opportunities including access to Asian, Hispanic/Latinx, African American, women, LGBTQ, veteran and disability-focused Business Resource Groups
Access to learning content on Degreed and other informational platforms
Your ethics and integrity will be valued by a company with a strong and stable ethical business with industry leading pay and benefits
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