Fallon Health Sales Account Advocate - Growing Healthcare Organization in Worcester, Massachusetts


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.

Position Overview:

Under the direction of Director, Retention Sales, represents Fallon Health in serving as a liaison between patients/members and health care system; with a high degree of empathy and advocacy, address member inquiries related to all Fallon Health products, benefits, policies, and procedures; responsible for maintenance and problem resolution, and member retention of identified accounts. Communicates system policy on member rights and responsibilities in accordance with Massachusetts General Law to both providers and members. Maintains regular contact and develop meaningful relationships with benefit administrators or key contact of identified accounts and promote member retention activities in support of Marketing and Enrollment efforts. Applies fine tuned analytical skills in supporting other Account Management staff regarding problem-solving, department procedural issues and health care system policies, protocols, and procedures with identified accounts.


Primary Job Responsibilities:

  • Responsible for maintenance, problem resolution, and member retention of assigned accounts.

  • Maintain solid working knowledge of all Fallon Health policies, protocols, and procedures as well as customer literature and product information.

  • Assist with the implementation of a new group and onboarding of new membership.

  • Address member inquiries from identified accounts as received concerning all Fallon products, group benefit exceptions, and Fallon Health policies, protocols, and procedures

  • Introduce any new information pertinent to each specific account.

  • Develop and maintain a close relationship with benefit administrator or key contact at identified accounts.

  • Utilize relationship with benefit administrator in order to better understand their benefits strategy.

  • Act as an advocate for members and help bring resolution to identified inquiries and concerns that can be time sensitive

  • Act as a liaison between members, clients and appropriate Fallon Health contacts.

  • Utilize customer service department for research and resolution of member issues.

  • Conduct routine service Q&A sessions at identified accounts as needed.

  • Coordination with other Fallon Health departments to provide information to identified accounts. (i.e.On site Wellness Programs).

  • Coordinate and support documentation and resolution of complaints or concerns within identified accounts.

  • Evaluate summary member servicing data for identified accounts for dissemination to appropriate departments.

  • Identify trends regarding current issues and bring forward to the sales team and management.

  • Actively participate in cross functional work groups to represent member pain points for commercial products to identify way to improve product to enhance member experience.

  • Work with provider practices and staff to resolve member questions concerns; in collaboration with Network Development and Management and other internal Fallon departments formulate improvement measures, education and response to patient;

  • Forward all documentation involving patient quality of care concerns to appropriate internal department

  • Direct member questions to appropriate Fallon Health department, Fallon Health Administrative services, affiliated hospitals, clinical staff and support services.

  • Cite areas where quality improvement measures are needed on-site and coordinate and/or implement appropriate recommendations in coordination with appropriate internal staff.

  • Advise members of Patient Rights and Responsibilities in accordance with Massachusetts General Law.

  • Promote and coordinate member retention activities and support Marketing /Enrollment effort.

  • Report and address member and employer group disenrollment issues.

  • Conduct question and answer sessions regularly and on-request with Plan accounts.

  • Conduct employer group presentations as needed.

  • Represent the Plan at company health/industrial fairs.

  • Research and perform special projects as required.

  • Compile ad hoc summary of identified accounts.

  • Assist in health care system-wide educational activities.

  • Attend and participate in planning and implementation of health education programs and community outreach projects.

  • Prepare and present special reports as needed.

  • Enhance Fallon Health image to build community relations by responding to social and human service


Education: 4 Year College Degree or relevant experience

Experience: 1+ Years previous experience in a Service or Sales capacity


  • Excellent oral and written communication and negotiation skills

  • Strong interpersonal skills and high degree of empathy

  • Ability to work independently and obtain specified goals and objectives with minimum supervision

  • Analytic Ability - Gathers relevant information systematically, grasps complexities and is able to work toward best possible outcome

  • Builds collaborative relationships and able to influence others

Additional Performance Requirements:

  • Excellent verbal and written communication skills (including public speaking and presentation skills)

  • Strong organizational and prioritizing skills

  • Solid problem solving and negotiating skills

  • Ability to protect high degree of confidential/privileged patient information

  • Computer skills

  • Ability to interact and communicate with executive and administrative personnel

Job ID 5514

# Positions 1

Category Sales