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Overview

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.

It takes a special person to work at Fallon Health. We take great pride in matching each person with the role that fits best. Our dedicated professionals are united by compassion for the people we help, each contributing to our unique and innovative approach to health care.

The Opportunity:

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 Fallon Health 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 Fallon Health 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.

Responsibilities

Position Overview:

This position shift is 10:30 am - 2:30 pm M-F, 4 hours/day, 20 hours/week. Potential to become remote after 7 weeks of onsite training.

The Member Services Representative is accountable for successfully addressing member and provider inquiries received through Fallon Health - 1-800 numbers, as well as, providing direction on Plan policies, procedures, and benefits.

Some key responsibilities include:

+ Ownership for development of knowledge and skills, as training program provides material and framework for success.

+ Ownership for customer satisfaction. Member Service Representatives are the primary liaison for our members to obtain the information or support they need As such, our representatives are expected to fully understand member/ provider needs, and within corporate/ department policies, take whatever action is necessary to fully satisfy the inquiry.

+ Clear and concise documentation of call detail for tracking of member/ provider contacts.

+ Identification and communication of trends that are indicative of enterprise service issues.

+ Escalation of member/provider concerns and servicing issues.

+ Appropriate execution of corporate and department policies/ practices.

Qualifications

Education:

+ High school diploma required, Bachelor’s degree or advanced education desirable

Experience:

+ 2+ years professional work experience preferably in a customer facing inbound call-center setting.

+ The ability to multitask and leverage strong typing skills and a high proficiency with MS Word, MS Excel and system data entry are essential tools for success in this role

+ Although this is a 40 hour work week role, we are looking for some shift flexibility as we move to a 12/7 operation with occasional evening and weekends.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

\#P03

**Location** _US-MA-Worcester_

**Posted Date** _3 weeks ago_ _(8/18/2025 1:45 PM)_

**_Job ID_** _8052_

**_\# Positions_** _1_

**_Category_** _Customer Service_