[Hiring] Customer Service Representative @firstsourc

Role Description

Job Title: CSR/Data Entry

Job Type: Full Time

FLSA Status: Non-Exempt/Hourly

Grade: H2

Function/Department: Health Plan and Healthcare Services

Reporting to: Team Lead/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 (LOB) 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.
• Access 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 when required to ensure all necessary information is available for downstream processing.
• Adhere to all HIPAA, data privacy, and security requirements when 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.

Company Description