Customer Service Representative

firstsourc•Remo, VA

4d•$14•Onsite

About The Position

The Customer Service Representative (CSR)/Data Entry role is a full-time, non-exempt/hourly position within the Health Plan and Healthcare Services department. This role reports to a Team Lead/Supervisor in Operations and has a pay rate of $14 per hour. The schedule is Monday through Friday from 1:30 PM to 10:00 PM EST, with the possibility of mandatory overtime. The primary responsibilities involve reviewing and processing Grievance and Appeals documents, identifying and assigning the correct Line of Business (LOB), determining dispute types, accessing multiple client systems for member information, and indexing documents accurately. The role also requires adherence to HIPAA and data privacy regulations, meeting productivity and quality standards, following client-specific procedures, and escalating issues as needed. Participation in quality audits and process improvement initiatives is also expected.

Requirements

Ability to review incoming Grievance and Appeals documents for completeness, legibility, and relevance.
Skill in accurately identifying and assigning the correct Line of Business (LOB).
Proficiency in determining and classifying dispute types.
Experience accessing multiple client systems and portals.
Ability to retrieve, verify, and validate member information.
Accuracy in indexing documents by entering required data fields.
Understanding of HIPAA, data privacy, and security requirements for handling PHI.
Ability to meet established productivity, accuracy, and quality standards.
Knowledge of client-specific workflows, job aids, and standard operating procedures.
Skill in identifying discrepancies, missing information, or indexing issues and escalating them.
Willingness to participate in quality audits, training updates, 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.