Customer Service Team Lead in Rocky Hill, CT at Beacon Health Options

Date Posted: 7/3/2018

Job Snapshot

Job Description

General Summary: Under the direction of the Member Customer Service Management Team, the Member Customer Service Representative (CSR) 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. 

Essential Duties and Responsibilities:

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

  1. Achieve and maintain productivity and quality performance expectations.
  2.  Interpret and effectively communicate benefits and eligibility and claims payment information to our customers.
  3. Facilitate resolution of complex claim issues.
  4. Document all critical information related to contacts responded to in the appropriate CONNECTS screen/system.
  5. Manage pending inventory in a timely and accurate manner in order to meet or exceed quality and productivity standards.
  6. Effectively navigate through multiple complex systems/screens.
  7. 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.
  8. Keep abreast of all system, contractual, compliance standard changes and policy updates, and attend additional training sessions as necessary.
  9. Complete daily assigned tasks by management that may include, but are not limited to; website inquiries, performance guarantee reports, negative coordination of benefit updates, and authorization for disclosure forms, authorization updates, and correspondence.
  10. Perform additional duties and/or work additional hours as needed.  Mandatory overtime and working holidays may apply based on business needs.
  11. Comply with all the HIPAA Compliance regulations.
  12. Adherence to work schedule including time spent on break/lunch
  13. Handle multiple clients that will include complex benefit structures and nuances.
  14. Demonstrate role model behavior and departmental best practices as a mentor for new staff.
  15. Manage various works queues and assist with escalated supervisory issues, including incoming and outgoing phone calls.
  16. Exhibit and maintain proficiency in most (if not all) client accounts. This includes all components of the client benefit, claim and nuance information.
  17. Other duties as assigned.

Minimum Entry Level Qualifications: Must possess the ability to function in an interdisciplinary setting. Must have knowledge and experience using management information systems. Strong customer

service orientation and excellent written and verbal communication skills required. Must be knowledgeable about care resources and levels of care availability.

  • Education: A high school/GED diploma is required.  An Associate’s Degree or equivalent related experience is preferred.
  • Licensures: n/a
  • Relevant Work Experience: One-year experience or proven performance in Customer Service, Health Care or Health Insurance is required. Strong verbal/written communication skills, typing skills and strong problem solving skills are also required. Previous experience in an ACD call center environment is preferred.
  • Supervise Staff?                YES              NO

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