Customer Service Representative (Remote, Remote, US)

Customer Service Representative (Remote, Remote, US) at firstsourc in United States.

Role Summary

• Start Date: Sept 14
• Job Title: CSR/ Data Entry - WFH
• Job Type: Full Time
• Pay: $14/hr
• FLSA Status: Non-Exempt/Hourly
• Grade: H2
• Function/Department: Health Plan and Healthcare Services
• Reporting to: Team Lead/Supervisor - Operations
• Schedule: Monday-Friday 1.30pm-clean desk (end time depends on workload)

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.