Customer Service Representative

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.