Customer Service Representative

Job Summary

Working remotely on a full-time hourly basis, the Customer Service Representative will review grievance and appeal documents, accurately classify disputes, and manage member information in compliance with client and regulatory standards.

Key responsibilities

• Review and assess incoming grievance and appeal documents for completeness and relevance
• Accurately classify dispute types according to client-specific guidelines and regulatory definitions
• Access and verify member information across multiple client systems while adhering to HIPAA and data privacy requirements

Required qualifications

• High school diploma or equivalent
• Experience in data entry or customer service roles
• Familiarity with healthcare regulations and HIPAA compliance
• Proficiency in using multiple computer systems and data management tools
• Ability to meet productivity and quality standards in a fast-paced environment