PHS Customer Service Representative

Duties and Responsibilities

• Data Accuracy & Attention to Detail: Perform precise data entry for claim control processes, ensuring accuracy and efficiency.
• Information Management: Scan claims into the clearinghouse for repricing and into PaperVision for electronic storage.
• Analytical Thinking & Problem-Solving: Review and resolve claims defaulted into SDS queues, identifying discrepancies and ensuring proper resolution.
• Cordination & Follow-Through: Manage the process of requesting medical records through vendors, ensuring proper documentation, timely follow-up, invoice reconciliation, and communication with the team once records are received.
• Quality Assurance: Review and check in claim submissions within both the claims agent and policyholder portals.
• Customer Service & Professional Communication: Handle incoming correspondence for claims, ensuring additional information requests are addressed promptly and accurately.
• Organizational Skills: Manage, distribute, and process incoming mail to support efficient workflow.
• Collaboration & Team Support: Work closely with peers and leadership to meet unit goals and support broader department initiatives.

Qualifications and Skills Required

• Strong attention to detail with proven organizational and time-management skills.
• Effective verbal and written communication abilities.
• Ability to manage multiple priorities in a high-volume environment.
• Demonstrated reliability, professionalism, and accountability in daily tasks.
• Proficiency with basic computer applications (e.g., Microsoft Word, Excel, Outlook).
• Strong teamwork and collaboration skills, with adaptability to changing priorities.
• Likely to have a high school diploma or equivalent (GED).

Preferred

• 1+ years of data entry, claims processing, or administrative support experience, preferably in healthcare or insurance.
• Familiarity with claims systems, clearinghouse processes, or document management tools.
• Bilingual communication skills (Spanish preferred).

Work Environment Requirements

• Professional office environment with standard hours (Mon-Fri, 8am-5pm); occasional extended hours during peak times.
• Frequent use of computer, phone, and standard office equipment.
• Regular interaction with staff, leadership, and customers in a fast-paced, high-volume setting.
• Occasional standing, walking, and lifting of up to 15 pounds (e.g., supplies or equipment).