Customer Service Representative (Remote, Remote, US)

About the Role

The role is full-time, with a schedule of Monday to Friday, 1:30 pm to 10:00 pm EST, and may require mandatory overtime. You will report to a Team Lead or Supervisor and will be expected to meet established productivity, accuracy, and quality standards.

In this role, you will have the opportunity to work with a variety of clients and healthcare systems, and to develop your skills in data entry, document management, and customer service.

What You Will Do

• 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
• 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

What We Are Looking For

• 1-2 years of experience in customer service, data entry, or a related field
• Strong digital skills, including proficiency in Microsoft Office and the ability to learn new software systems
• Excellent communication and problem-solving skills
• Ability to work in a fast-paced environment and meet productivity standards
• Strong attention to detail and ability to accurately enter data into systems
• Knowledge of HIPAA regulations and guidelines
• High school diploma or equivalent required

Nice to Have

• Experience working in the healthcare industry or with healthcare clients
• Familiarity with customer service software and systems
• Certification in customer service or a related field
• Bilingual or multilingual skills

Benefits and Perks

• Competitive hourly rate
• Opportunities for professional growth and development
• Flexible remote work arrangements
• Access to training and development programs
• Health and wellness benefits
• Paid time off and holidays
• Retirement savings plan
• Employee recognition and reward programs

• Make sure to highlight your customer service experience and skills in your application, especially if you have experience working in the healthcare industry.
• Be prepared to provide examples of times when you had to handle difficult customer situations or resolve complex issues.
• Familiarize yourself with HIPAA regulations and guidelines, and be prepared to discuss how you would adhere to them in this role.
• Practice your data entry skills and attention to detail, as these will be critical in this position.
• Consider obtaining a certification in customer service or a related field to increase your chances of standing out as a candidate.
• Be prepared to discuss your experience with software systems and technology, and how you would apply this experience to the role.
• Research the company culture and values, and be prepared to discuss how you would fit in and contribute to the team.