Customer Service Rep II in Woburn, MA at Beacon Health Options

Date Posted: 7/30/2019

Job Snapshot

Job Description

Under the direction of Customer Service management team, the CSR II is responsible for answering and responding to a high volume of telephone inquiries from members and providers. The incumbent’s responsibilities include providing accurate and thorough interpretation of benefits, eligibility, claims payment and interpretation, providing accurate technical information, resolving customer inquiries, facilitating problem resolution, and acting as a member/provider advocate by meeting or exceeding customers’ expectations.  The CSR is expected to take complete responsibility for every interaction with a customer by providing outstanding service as a means to build customer loyalty, improve customer retention and satisfy corporate customer service goals and objectives. 

The CSR II will perform the following duties in a typical call center environment, which entails handling a high volume of calls while located at a desk.  The position requires adherence to schedules and extended periods of time on the phone .

•         Provide timely, accurate, and courteous responses to a high volume of telephone inquiries from both members and providers.

•         Meet daily production standards as indicated by management to meet overall ASA/ABA and client PG’s: includes attendance, adherence to schedules, ACW, calls per day, turnaround times. 

•         Maintain adherence to schedule enabling the team to meet client satisfaction levels.

•         Adherence to work schedule including time spent on break/lunch.

•         Achieve and maintain productivity and quality performance expectations; minimum 95%

•         Interpret and effectively communicate benefits and eligibility and claims payment information to our customers.

•         Document all critical information related to contacts responded to in the appropriate in house healthcare systems

•         Demonstrate professionalism, empathy and a sense of urgency on each and every member and provider call/transaction

•         Effectively navigate through multiple complex systems/screens.

•         Have the knowledge around handling escalated calls

•         Provide timely follow-up with other internal departments to expedite resolution of difficult/aging inquiries, and when necessary escalate those issues to management for further handling.

•         Keep abreast of all system, contractual, compliance standard changes and policy updates, and attend additional training sessions and department meetings as necessary.

•         Complete daily assigned tasks by management such as website inquiries, COB coordination of benefit updates, and authorization for disclosure forms, authorization updates, and correspondence.

•         Perform additional duties and/or work additional hours as needed. Overtime and working holidays may be required based on business needs.

•         Comply with all the HIPAA Compliance regulations.

•         Interpret and effectively communicate benefits, eligibility, claim payment information, web inquiries and inventory projects assigned by management to our customers.

•          Effectively handle complex correspondence.

•          Lead by example and exhibit role model behavior.

•         Identify CSR training needs by acting as a subject matter expert and mentor for less experienced staff.

•         Identify opportunities for process improvement, and offers problem resolutions.

•         Assist in handling complex and/or escalated telephone inquiries in a timely and accurate manner in order to meet or exceed quality and productivity standards. 

•         Meet work plan goals; AHT under 8 minutes, Adherence 80%, QA average 95%, Compliance with Relias trainings 98%

•         Sustain minimum of 3 months free of corrective action.

 Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled