Member & Provider Service Representatives - Work from Home

Positions are full-time, work-from-home roles with a Monday–Friday schedule. Actual shifts may vary between 8 AM – 6 PM EST.

About the role

In this role, you will serve as the first line of support for our stakeholders by providing accurate and thorough information to current and prospective members, providers, and internal customers about our various health plans. This role has proven to be an excellent starting point for long-term growth and advancement in our company.

Our Investment In You

• High-performing representatives may be eligible for promotion and pay increases within their first year through our Career Progression program
• Annual Commitment to Service bonus for Customer Care representatives (program requirements apply)
• Opportunity to grow your career within the company; qualified internal candidates are given preference when possible
• Various department-specific and company-wide reward and recognition programs
• Paid 12-week training period
• New hire buddy program
• Dedicated Team Assist Line to support complex/challenging calls in real time
• Robust training and skills development through Ulysses Learning, a leader in customer service and call center learning programs
• One-on-one coaching and mentoring from dedicated training and quality professionals
• Comprehensive employee benefits and generous paid time off program
• Business Resource Groups (BRGs) for professional growth and networking

Responsibilities

• Own each customer interaction by utilizing appropriate resources to accurately interpret and respond to inquiries
• Deliver outstanding, empathetic service that fosters trust, builds loyalty, and contributes to member retention
• Respond to a high volume of inbound calls from members and providers, addressing a wide range of topics
• Apply strong interpersonal and conflict-resolution skills to manage challenging calls with professionalism, courtesy, and empathy
• Record call details and customer interactions accurately in accordance with departmental standards and compliance requirements
• Work collaboratively with peers and cross-functional teams to resolve issues and contribute to shared goals
• Consistently meet or exceed departmental goals related to quality, productivity, customer satisfaction, and compliance
• Support the department by performing additional duties as needed, demonstrating reliability and adaptability

Requirements

• Prior work experience in a customer-facing position
• Demonstrated career progression preferred
• A minimum of three consecutive years in a previous role
• Completion of a 60–90 minute competency assessment (required step in hiring process; must be completed on a laptop or desktop computer)
• Outstanding professional references from prior supervisors
• Successful completion of a pre-employment background check, including criminal history and verification of education and last three employers
• Quiet, distraction-free, private, and secure workspace for remote work
• High-speed internet connection
• Regular and reliable attendance
• Ability to work overtime during peak periods

Qualifications

• High school diploma or equivalent required; bachelor’s degree preferred
• Prior professional work experience, ideally in customer service
• Outstanding customer service skills
• Excellent verbal and written communication skills
• Strong organizational skills with the ability to prioritize a high volume of tasks
• Ability to make sound business decisions based on established standards and guidelines
• Working knowledge of Microsoft Office products
• Bilingual in Spanish, Portuguese, Haitian Creole, or other language is highly desirable

Pay

Starting compensation range: $19.50 per hour. This range offers an estimate based on minimum job qualifications. Actual base pay is determined by a broad range of factors, including education, experience, skills, certifications/licensure, business needs, internal equity, and market competitiveness.

Benefits

• Medical, dental, vision, and pharmacy benefits
• Merit increases
• Flexible Spending Accounts
• 403(b) savings match
• Paid time off
• Career advancement opportunities
• Resources to support employee and family wellbeing

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

WellSense is hiring in the following states: Alabama, Arizona, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin.