Data Entry/Customer Service Representative
About The Position
This is a full-time, non-exempt/hourly position in the Health Plan and Healthcare Services department. The role involves reviewing incoming Grievance and Appeals documents for completeness, legibility, and relevance. Responsibilities include identifying and assigning the correct Line of Business (LOB), determining and classifying dispute types, accessing multiple client systems to verify member information, and indexing documents by entering required data accurately. The position also requires normalizing and preparing documents, adhering to HIPAA and data privacy regulations, meeting productivity and quality standards, following client-specific workflows, identifying and escalating discrepancies, and participating in quality audits and training.
Requirements
- Facets experience is given preference in hiring
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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
