Group Health PRN Customer Service Representative

JOB SUMMARY

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

Dane Street’s success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

Dedicated time and focus during assigned shifts are required to maintain productivity.

Status: PRN

Shifts Available:

• Days
• Weekends
• Evenings

MAJOR DUTIES & RESPONSIBILITIES

Handling Receipt of New Cases:

• Intake new cases and review/verify information and requests. Draft cases by entering information into the Dane Street system, AccessDS.
• Work with client on any information missing pertinent to processing claim.
• Sort, organize and create medical document listing - if required by client, and in line with specific special handling.

Assignment of Cases:

• 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.

Oversight of Cases:

• Monitor, process and track cases to ensure we meet deadlines.

Client Interaction:

• 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.

Other duties & special projects, as assigned and based on business needs.

EDUCATION/CREDENTIALS:

An Associate’s Degree is preferred.  

JOB RELEVANT EXPERIENCE:

Business experience in a healthcare and/or insurance setting is preferred.         

JOB RELATED SKILLS/COMPETENCIES:

Present exceptional communication skills with a clear understanding of company business lines.  The ability to apply critical thinking, manage time efficiently and meet specific deadlines.  Computer literacy and typing skills are essential.

WORKING CONDITIONS/PHYSICAL DEMANDS:

Any lifting, bending, traveling, etc. required to do the job duties listed above.  Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

Supply and support their own internet services. 

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.

We offer generous Paid Time Off, an excellent benefits package, and a competitive salary. If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.