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, working remotely. The primary responsibilities involve reviewing and processing Grievance and Appeals documents, accurately identifying lines of business and dispute types, and managing member information across multiple client systems. The role requires strict adherence to HIPAA and data privacy regulations, meeting productivity and quality standards, and following established workflows and procedures.

Requirements

Proficiency in data entry and indexing.
Ability to access and navigate multiple client systems and portals.
Understanding of member demographics, ID numbers, and plan/eligibility details.
Knowledge of HIPAA, data privacy, and security requirements for handling PHI.
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 or missing information.

Nice To Haves

Experience with Grievance and Appeals processing.
Experience in the Health Plan and Healthcare Services industry.

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.