A Behind-the-Scenes Look at our Member Services Team
From choosing a PCP to understanding bills to navigating transgender health care, our member services staff are here to help
The Member Services Department at Tufts Health Plan, which includes the Member Experience Department, is our direct connection to our members. Our staff there works hard every day to answer members’ questions, resolve their issues, and take proactive action to make the member experience as seamless as possible.
We recently spoke with John McManus, Call Center Manager, and Emily Bonacci, Manager of Member Experience, to learn more about their work and the Tufts Health Plan approach to serving members.
THP: To start things off, can you each tell us a bit about your role and responsibilities? What does your day-to-day look like?
Emily: I have three different teams. One team works directly with the commercial sales department, where our inquiries from employers and brokers come through. The sales team doesn't have to try and figure everything out on their own—they have us in their back pocket, supporting them. Another team directly supports the call center, and the third one fields customer inquiries that come in via email or mytuftshealthplan.com or any other department. We’re a very consultative group, so we also offer our support to any department at Tufts Health Plan that's working with a member.
John: My main role is to support our call center supervisors, who in turn support and develop the customer representatives on the front lines. Sometimes, if the representatives or the supervisors haven’t been able to resolve something for whatever reason, it may come to me. Both the supervisors and managers are out touching base with the customer representatives every day, seeing how they're doing, looking at how many calls are in the queue, how long people are waiting. We’re very involved.
THP: What kind of direction do you give your staff in terms of how they should address member issues and improve member experience? Is there a guiding philosophy?
Emily: For me it's let’s fix it, let's make it better. If a particular member brought something to our attention because it’s complex or confusing, it means that potentially more members could also be feeling that way. We want to make sure that it's clear for any other members as well, whether it’s documentation that needs to be updated, or we need some kind of marketing campaign to clear things up. You really do want to exceed their expectations. You want to create an experience where the member thinks, “Wow, I can't believe my health plan did that.”
For me it's let's fix it, let's make it better.
-Emily Bonacci, Manager of Member Experience
John: I like to hear representatives really engaging the member, taking an interest in what's going on. Sometimes it’s a very straightforward issue, like a quick PCP change, but we also have people who are calling because they're running into problems. Maybe they’ve got an illness in their family or they’re getting a bill they don’t understand, which can both be very stressful. When I hear someone showing empathy to somebody who's having a problem, I let them know they’re doing a great job.
When I hear someone showing empathy to somebody who's having a problem, I let them know they're doing a great job.
-John McManus, Call Center Manager
THP: Can you think of any examples of when you feel like you’ve been able to make a real difference in members’ lives?
John: I worked with a member once who was trying to get coverage for a piece of medical equipment, which was initially denied. I worked with him on getting more documentation from the specialist and submitted the claim for further review and we were ultimately able to get it covered. There are some situations you just can’t fix. There’s no way around it. But when I can come up with a solution to somebody’s problem that they’re happy with, it makes me feel really good.
Emily: We've made some really great progress with our transgender members, in terms of bringing attention to new codes and things that should be considered for coverage. Our transgender members are really appreciative once they find out that they have more coverage than they thought, and that they have a team here that will help support them.
THP: Tufts Health Plan earns high marks when it comes to member experience.1 What is it about the company that helps makes this possible?
John: It probably sounds cliché, but I think it's the people. Not just in the call center, but with all the people I work closely with, including Emily’s team. Everyone is really bought into the idea that we're here to try to service the member, and that at the end of the day we're going to be judged on how well we do that.
...we need to make sure we're doing things right the first time, for that member or employer and any future ones who may be impacted.
-John McManus, Call Center Manager
Emily. I think we do a great job with training and hiring. Everyone feels like family, so they want to help, and they want to do better. Even front-line staff in the call center aren’t afraid to stick with an issue, because they know we can get there, it just may take some time. We give them a lot of resources and additional support from their managers and supervisors. Anyone can walk anywhere and ask a question and get the help they need.
THP: Anything else you’d want people considering Tufts Health Plan to know?
Emily: I’d want them to know that our ultimate goal is to resolve things as best we can and as quickly as we can. And I know there may be times when it doesn’t feel like that. But we need to make sure we're doing things right the first time, for that member or employer and any future ones who may be impacted. We want to be constantly improving.
John: We really do value trying to resolve any issues our members run into. And if they're just calling for routine things, we want to make that as simple and as painless as possible, too.
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