Customer Service Representative

firstsourc•Remo, VA

5d•Remote

About The Position

This is a full-time, non-exempt/hourly position for a CSR/Data Entry role with remote work capabilities. The primary function involves reviewing and processing Grievance and Appeals documents, ensuring accuracy in identification, classification, and data entry across multiple client systems. Adherence to HIPAA, data privacy, and security requirements is paramount. The role requires meeting productivity, accuracy, and quality standards while following specific client workflows and procedures. Participation in quality audits and process improvement initiatives is also expected.

Requirements

Proficiency in reviewing documents for completeness, legibility, and relevance.
Ability to accurately identify and assign Line of Business (LOB).
Skill in determining and classifying dispute types.
Experience accessing and navigating multiple client systems and portals.
Accurate data entry skills for internal systems or client platforms.
Understanding of document normalization and preparation.
Knowledge of and adherence to HIPAA, data privacy, and security requirements.
Ability to meet productivity, accuracy, and quality standards.
Familiarity with client-specific workflows, job aids, and standard operating procedures.
Skill in identifying and escalating discrepancies, missing information, or indexing issues.

Nice To Haves

Experience with Grievance and Appeals processing.
Familiarity with healthcare services and health plans.
Experience with quality audits and process improvement initiatives.

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.