Customer Service Representative
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At a glance
Job overview
The role involves reviewing grievance and appeal documents, identifying the line of business, classifying dispute types, accessing client systems to verify member information, indexing data, ensuring HIPAA compliance, and meeting productivity standards.
Skills & qualifications
Skills
Qualifications
Full job description
Experience Required
None
Minimum Education Required
High School Diploma/G.E.D.
Compensation
$7.25 / hourly
Hours Per Week
40
Number Of Positions
1
Work Schedule and Shift Requirements
First (Day)
Job Description
Start Date: Sept 14
Job Title: CSR/Data Entry - WFH
Job Type:Full Time
Pay :$14/hr
FLSA Status:Non-Exempt/Hourly
Grade:H2
Function/Department:Health Plan and Healthcare Services
Reporting to:Team Lead/Supervisor - Operations
Schedule: Monday-Friday 1.30pm-clean desk (end time depends on workload)
Key Responsibilities
Review incoming Grievance and Appeals documents for completeness, legibility, and relevance.
Accurately identify and assign the correct Line of Business (LOB) based on client and regulatory definitions.
Determine and classify the dispute type (e.g., grievance, appeal, expedited appeal, standard appeal) in accordance with client-specific guidelines.
Access multiple client systems and portals to retrieve, verify, and validate member information, including but not limited to: Member demographics Member ID numbers Plan and eligibility details Index documents by entering required data fields accurately into internal systems or client platforms.
Normalize and prepare documents when required to ensure all necessary information is available for downstream processing.
Adhere to all HIPAA, data privacy, and security requirements when handling protected health information (PHI).
Meet established productivity, accuracy, and quality standards.
Follow client-specific workflows, job aids, and standard operating procedures.
Identify discrepancies, missing information, or indexing issues and escalate according to established procedures.
Participate in quality audits, training updates, and process improvement initiatives as required.
Job Type
Full time
Benefits Offered
Not specified
Veteran Preference
No
Place of Work
On-site
Requisition ID
23533
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