Customer Service Representative I in Coral Gables, FL at Beacon Health Options

Date Posted: 3/16/2020

Job Snapshot

Job Description

Under the direction of  the Customer Service Management Team, the Customer Service Representative I 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, provider participation, claims payment and interpretation inquiries, 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. 

Position Responsibilities:

  • Provide timely, accurate, and courteous responses to a high volume of telephone inquiries from both members and providers.
  • Achieve and maintain productivity and quality performance expectations.
  • Interpret and effectively communicate benefits and eligibility and claims payment information to our customers.
  • Facilitate resolution of complex claim issues
  • Document all critical information related to contacts responded to in the appropriate FlexCare or CONNECTS screen/system.
  • Manage pending inventory in a timely and accurate manner in order to meet or exceed quality and productivity standards.
  • 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 as necessary.
  • Complete daily assigned tasks by management such as website inquiries, performance guarantee reports, negative coordination of benefit updates, authorization for disclosure forms, authorization updates, and correspondence.
  • Perform additional duties and/or work additional hours as needed.  Mandatory overtime and working holidays may apply based on business needs.
  • Comply with all the HIPAA Compliance regulations.

Knowledge, Skills & Abilities:

  • Strong verbal communications skills
  • Written communication skills
  • Problem solving skills
  • Microsoft Office

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 

At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email ( Only candidates who have applied for an open position through our Careers page ( will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you. 


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