Hybrid Customer Experience Consultant

at MassMutual

• Job title: Customer Experience Consultant
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $90,500 - $118,700 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Springfield, United States

About the role

• Customer Experience Consultant in MassMutual's Worksite team, providing support for supplemental health operations. Conduct audits, handle claims inquiries, and optimize processes for improved service quality.

Responsibilities

• Conduct target audits on invoices for supplemental health insurance policies; applied premium, outstanding and suspense payments, and billing discrepancies
• Review and evaluate claims for Accident and Critical Illness products, ensuring compliance with policy terms, regulatory requirements, and state guidelines
• Review and communicate process policy changes, updates, quotes, cancellations, and respond to client inquiries regarding policy details, coverage, and claims
• Handle escalated inbound/outbound calls and emails regarding claims, billing, policy servicing, and portal issues
• Provide exceptional customer service and troubleshoot customer inquiries
• Document use cases, test scenarios, procedures, and decisions needed for operational readiness
• Execute on testing and support User Acceptance Testing (UAT) for claims and billing processes
• Navigate process and customer journey maps, translating insights into operational readiness and improvements
• Develop, review, and maintain Standard Operating Procedures (SOPs) to ensure efficient and up-to-date processes
• Curate and manage a central repository of playbooks, best practices, and resources to support day-to-day tasks
• Work effectively across functional and organizational boundaries, collaborating with Business Analysts (BA), Product Owners (PO), Project Managers (PM), and other stakeholders
• Take ownership of processes from billing to payment, including analysis of flows and requirements, and drive execution
• Support integration of claims with external providers and manage add-on services
• Review current customer service setup (call tree, talking points), analyze flows, and recommend improvements
• Leverage experience with policy administration platforms, and Electronic Data Interchange (EDI)
• Support and assist with Third Party Administrator (TPA) claims training, and review/co-sign TPA claims and billing refunds for accuracy and compliance
• Assist in monitoring CSR performance to ensure service standards are met

Requirements

• 5+ years of Insurance Industry experience and/or supplemental or group health insurance operations, claims backend, billing, and policy servicing
• Experience in customer service, claims adjudication, billing, and policy administration
• Exposure to technical platforms (EIS, EDI) and process improvement initiatives
• Experience supporting TPA operations and training
• Experience in documenting use cases, test cases, procedures, and decisions; ability to analyze and translate process maps into actionable steps
• Ability to navigate and interpret process and customer journey maps
• Proven ability to work in a matrix environment, manage execution, and collaborate across functions (BA, PO, PM, etc.)
• Comfortable taking on E2E responsibility and driving results
• Experience working in Agile environments
• Exposure to quoting, product setup, and enrollment processes in addition to servicing
• Experience with EIS or similar platforms; familiarity with EDI
• Experience working with TPAs and understanding their processes
• Strong communication and interpersonal skills; ability to review and optimize customer service flows
• Experience in monitoring and improving team performance
• Ability to develop SOPs and conduct UAT for claims and billing
• Proficiency in MS Excel and reporting tools
• Understanding of HIPAA, ERISA, and state regulations
• High level of accuracy and attention to detail
• Strong critical thinking and decision-making skills
• Ability to work under pressure, meet deadlines, and adapt to changing priorities

Benefits

• Regular meetings with the Worksite Supplemental Health Operations Team
• Focused one-on-one meetings with your manager
• Networking opportunities including access to Asian, Hispanic/Latinx, African American, women, LGBTQ, veteran and disability-focused Business Resource Groups
• Access to learning content on Degreed and other informational platforms
• Your ethics and integrity will be valued by a company with a strong and stable ethical business with industry leading pay and benefits