Customer Service Representative - Seasonal account 20k

Common Roles in a Healthcare BPO Account

1. Customer Service Representative (CSR)

Handle calls from patients or members

Assist with insurance coverage, benefits, claims status, appointments, etc.

Provide information about healthcare plans

2. Claims Processor / Claims Examiner

Review and process insurance claims

Check accuracy of patient info, billing codes, and eligibility

Approve, deny, or escalate claims

3. Medical Billing & Coding Specialist

Convert patient procedures and diagnoses into medical codes

Prepare and submit claims to insurance companies

Ensure compliance with HIPAA and billing rules

4. Prior Authorization Specialist

Coordinate with doctors and insurers

Validate if a procedure or medication needs approval

Manage documentation and follow-ups

5. Healthcare Enrollment Specialist

Guide members through enrollment in health plans

Update records, verify identity, and assist with renewals

6. Provider Support Specialist

Assist doctors, clinics, and hospitals

Resolve issues about claims, reimbursements, or credentialing

7. Utilization Management (UM) Support

Review medical records to ensure services meet guidelines

Work with nurses or clinicians to validate medical necessity