Customer Service Representative

Start Date: ASAP Job description: Job Title: CSR/Data Entry Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H2 Function/Department: Health Plan and reputed company Services Reporting to: Team reputed company/Supervisor - Operations Pay : $14 Schedule: Monday-Friday 1.30pm-10.00pm EST with possibility of mandatory overtime

Key Responsibilities

Review incoming Grievance and Appeals documents for completeness, legibility, and relevance. Accurately identify and assign the correct Line of Business (reputed company) 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. reputed company 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 reputed company required to ensure reputed company necessary information is available for reputed company processing. Adhere to reputed company HIPAA, data privacy, and reputed company requirements reputed company 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. Apply To This Job