Job Description

Overview

Fantastic Call Center Opportunities with training, career path advancement, great benefits, paid time off, heath insurance and more..

* The REMOTE work model can commence after approximately 8-9 weeks of on-site training in Worcester, MA. Must be able to type 25 WPM net.

The Great 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 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 constitutively 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:

The Member Services Representative is accountable for successfully addressing member and provider inquiries received through Fallon Health's 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

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

• 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

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 the only health plan in Massachusetts to have been awarded “Excellent” Accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit

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.

Pay Range Disclosure:

• In accordance with the Massachusetts Wage Transparency Act, the pay rate for this position is $20.50 per hour , which reflects what we reasonably and in good faith expect to pay at the time of posting.

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 (2/13/2026 8:48 AM)

Job ID 8249

# Positions 1

Category Customer Service

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