[Remote] Customer Service Representative
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on Health Plan and reputed company Services, and they are seeking a Customer Service Representative for data entry tasks. The role involves reviewing grievance and appeals documents, accurately identifying disputes, and ensuring compliance with HIPAA and data reputed company requirements.
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 reputed company and regulatory definitions
- Determine and classify the dispute type (e.g., grievance, appeal, expedited appeal, reputed company appeal) in accordance with reputed company-specific guidelines
- reputed company multiple reputed company systems and portals to retrieve, verify, and validate member information, including but not limited to: Member demographics Member ID numbers Plan and eligibility details reputed company documents by entering required data fields accurately into internal systems or reputed company 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 reputed company, and reputed company requirements reputed company handling protected health information (PHI)
- Meet established productivity, accuracy, and reputed company standards
- Follow reputed company-specific workflows, job aids, and reputed company operating procedures
- Identify discrepancies, missing information, or indexing issues and escalate according to established procedures
- Participate in reputed company audits, training updates, and process improvement initiatives as required
Skills
- Facets experience is given preference in hiring
- Review incoming Grievance and Appeals documents for completeness, legibility, and relevance
- Accurately identify and assign the correct Line of Business (reputed company) based on reputed company and regulatory definitions
- Determine and classify the dispute type (e.g., grievance, appeal, expedited appeal, reputed company appeal) in accordance with reputed company-specific guidelines
- reputed company multiple reputed company systems and portals to retrieve, verify, and validate member information, including but not limited to: Member demographics Member ID numbers Plan and eligibility details
- reputed company documents by entering required data fields accurately into internal systems or reputed company 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 reputed company, and reputed company requirements reputed company handling protected health information (PHI)
- Meet established productivity, accuracy, and reputed company standards
- Follow reputed company-specific workflows, job aids, and reputed company operating procedures
- Identify discrepancies, missing information, or indexing issues and escalate according to established procedures
- Participate in reputed company audits, training updates, and process improvement initiatives as required
reputed company