Remote Customer Service Representative

Job Summary

Working remotely on a full-time basis, the Customer Service Representative will manage grievance and appeals documentation, ensuring accuracy and compliance with client guidelines while adhering to HIPAA regulations.

Key responsibilities

• Review and assess incoming grievance and appeals documents for completeness and relevance
• Accurately classify dispute types and assign the correct Line of Business based on client definitions
• Access and validate member information across multiple client systems and ensure data is entered accurately into internal platforms

Required qualifications

• High school diploma or equivalent
• Experience in healthcare or customer service environments
• Familiarity with HIPAA regulations and data privacy standards
• Proficiency in using multiple computer systems and data entry tools
• Ability to work flexible hours, including afternoons