Fallon Health

Business Analyst

• Monitor real time all call distribution
• Manage all technology needs, working with IT and others as needed
• Develop and execute/ coordinate execution of all testing needs
• Monitors all new implantation progress
• Track technology issues and manage resolution through IT processes
• Represent Customer Service on all technology projects, planning and executing on all testing requirements
• Monitor incoming calls across all lines of business to ensure real time re-distribution if necessary.
• Provide real time guidance and resolution of both technical and non-technical issues within the department.
• Support of incoming call volume to enable real-time queue management and associated staffing implications.
• Troubleshoot technology issues for all of the customer service team.
• Identify and bring forward to management and leadership new Process Improvement project opportunities.
• Document and maintain Process Improvement learning and share best practices across Customer Service teams.
• Provide training and mentoring to Call Center staff as needed or directed.
• Serve as liaison with various internal departments, including IT and OSS, to resolve technical issues for the CS team.

Call Center Technology Analyst, Workforce Management Specialist

Administrative Assistant

• Develops presentations independently and in collaboration with Communications and Compliance
• Facilitates presentations to various target audiences
• Attend and assist with planning of educational and outreach events
• Coordinate interaction with various roles for handling customer requests
• Assure compliance with Medicare & Medicaid enrollment and marketing policies

Administrative Operations Coordinator

• Lead cross-functional teams
• Collaborate on development and submission of annual rate filings
• Act as the subject matter expert for product filings
• Partner with various teams for product-related inquiries
• Develop and deliver product training

Product Manager III – Health Plan Product Experience

General

• Maintains active and consistent availability on the phone system, as scheduled, for all lines of business both Commercial and Regulatory.
• Meets internal/external deadlines and remains in compliance with CMS and EOHHS regulations
• Prioritizes daily and weekly work
• Responsible for maintaining professional relationships with customers/vendors; including resolving identified discrepancies in a timely manner
• Works proactively to ensure the enrollment and billing records are kept current and accurate. Ensures goals and turnaround standards are being met or exceeded based on corporate and departmental metrics.
• Responsible for maintaining up to date primary care physician assignments in core system accurately and timely. This is to be completed through review of data integrity reports, and working closely with Customer Service, Provider Relations, Contracting and ---- Account and Provider Configuration.
• Maintains professional etiquette and positively represents Fallon Health when meeting in-person with customers for eligibility and premium related inquiries.
• Assists with core system upgrade testing
• Completes other tasks assigned.
• Creating/maintaining desk top procedures and P&P’s
• Participates in departmental and company-wide process improvement projects, training, upgrade testing and team meetings as assigned.
• Performs other duties as they are assigned to meet department performance goals and to respond to changing priorities including administrative related tasks.
• Works department returned mail
• Responsible for maintaining up to date productivity records on a daily and monthly basis for corporate and departmental dashboards.

Medicaid Eligibility Specialist – Medicaid Application Experience

Product Manager

• Lead cross-functional teams for successful product implementations
• Collaborate on annual rate filings with product ownership
• Act as primary subject matter expert for product filings
• Develop internal and external product training
• Report on product portfolio performance

Call Center Technology Analyst, Workforce Management Specialist

Administrative Operations Coordinator

Product Manager III – Health Plan Product Experience

Medicaid Eligibility Specialist – Medicaid Application Experience

Product Manager – Senior