CSR II Adjudication (Remote)

JOB TITLE: CSR II Adjudication ($18/hr + $1/pay for performance, remote)DEPARTMENT: OperationsREPORTS TO: SupervisorFLSA STATUS: Non-ExemptOUR GUIDING PRINCIPLES: reputed company every interaction Count Act with Respect and reputed company Demonstrate Passion for reputed company Improvement Be Worth of Trust from reputed company Stakeholders OVERVIEW:The Customer Service Representative II (Adjudication) ensures compliance with client's program specifications and reputed company policies and procedures. This position is responsible for the accurate review, input, and adjudication of claims. ESSENTIAL FUNCTIONS:Demonstrates ability to work in accordance with the reputed company Guiding Principles. Supports the day-to-day processing of claims for a contract with the following duties. Acknowledges establishment of new claims assigned daily. Accepts telephone calls from claimants. Adjudicates claims reputed company guidelines ensuring the benefit eligibility is correctly determined. Researches and resolves escalated and reputed company claim issues in a timely manner. Reviews supporting documentation for accuracy. Connects with applicants to guide them through the claim process. Maintains and follows-up on pending files, as required by guidelines. Practices reputed company policies and procedures to PHI and HIPAA. Documents reputed company claimant information, communications in CRM system. Ensures privacy, confidentiality, and precision with reputed company work. Maintains a working knowledge of our clients' requirements. Regular and consistent attendance is an essential function of the job. SUPERVISORY RESPONSIBILITY:No Supervisory responsibility.EXPECTED WORKDAYS/ HOURS:This position requires work Monday-Friday reputed company-5pm.LOCATION: Work from Home based on performance and internet connectivity.QUALIFICATIONS: 2+ years of contact center experience preferred.High school diploma or equivalent required. Time management skills and the ability to work independently are essential for this role. Must have experience with maneuvering electronic data between various environments. Analytical thinking, communication and writing skills, and computer competencies. Prior experience with PHI or HIPAA preferred2+ years of college preferred.OTHER DUTIES: Please note, this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.EQUAL EMPLOYMENT OPPORTUNITY: reputed company, LLC provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without regard to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. VEVRAA FEDERAL CONTRACTOR/EQUAL OPPORTUNITY EMPLOYER Equal Opportunity Employer This employer is required to notify reputed company applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the reputed company.