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Role Description

The Customer Service Representative is responsible for the receipt of new cases and ensuring proper system drafting and setup. The CSR is also responsible for taking direction and facilitating the case assignment/scheduling process.

• Intake new cases and review/verify information and requests.
• Draft cases by entering information into the Dane Street systems.
• Work with the client on any missing information pertinent to processing the claim.
• Sort, organize, and create a medical document listing, if required by the client, in line with specific special handling.
• Respond to inbound calls, emails, and portal inquiries.
• Maintain efficient and accurate records related to all client interactions.
• Ensure compliance with Federal NSA regulations, processes, and policies.
• Collaborate with the Leadership team and other departments to ensure timely resolutions.
• Ability to process and interpret reporting.
• Adhere to or exceed metrics/goals.
• Assign/schedule new cases to physicians for review with the appropriate physician, based on location, reviewer availability, specific guidelines, jurisdictional requirements, and other client requirements.
• Ensure that the assigned physician has no conflict of interest with the case assignment.
• Monitor, process, and track cases to ensure we meet deadlines.
• Update clients frequently on cases in progress.
• May communicate when there are questions on referral information to ensure proper documentation and information is provided to the assigned reviewer.
• Ensure proper documentation for specified cases is provided to the client.
• Maintain consistent professionalism at all times.
• Other duties & special projects, as assigned and based on business needs.

Qualifications

• An Associate’s Degree is preferred.

Requirements

• Business experience in a healthcare and/or insurance setting is preferred.
• Healthcare claims and billing experience.
• Conflict resolution and de-escalation skills.
• Exceptional communication skills with a clear understanding of the company's business lines.
• Ability to apply critical thinking, manage time efficiently, and meet specific deadlines.
• Computer literacy and typing skills are essential.
• Customer focus, problem-solving, professionalism, integrity, customer excellence, and time management.

Benefits

• Comprehensive benefits package including medical, dental, and vision coverage for you and your family.
• Voluntary life insurance options for you, your spouse, and your children.
• Other voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
• Basic life insurance, short-term disability, and long-term disability coverage at no cost.
• Generous paid time off policy.
• 401k plan with a company match.
• Apple equipment and a media stipend provided for remote workspace.