Offshore CSR

Job Title: Customer Service Representative (CSR) - APS Retrieval

Team: Offshore CSR Calling Team

Shift: US Shift (night)

Role Overview

The CSR manages the retrieval of APS and medical records on behalf of US insurance clients. This covers provider follow-ups by phone and email, keeping case documentation accurate, raising client approvals and notifications on time, and resolving escalated cases within agreed turnaround times. Because every case involves Protected Health Information (PHI), the role depends on human judgment and manual verification at each step, so the right records and authorizations stay with the right case and errors are prevented before they reach the client.

Key Responsibilities

Provider Follow-up and Escalations

• Review orders and make outbound calls to medical providers on escalated cases, handling live conversations to clarify requirements and speed up record retrieval.
• Send email follow-ups to providers and facilities on pending requests.
• Handle client escalations, investigate the case history, and give timely, accurate resolutions.
• Review NYL cases and document a clear, case-specific reason for escalation.

Client Communication

• Send client notifications for Banner cases as per the client’s requirements, checking case details before sending so the correct client receives the correct information.
• Email clients for approval when providers charge fees for records.
• Notify clients when a provider confirms that records will not be released, with the reason.

Case Management and Data Quality

• Review and close duplicate cases and cases that have exceeded the allowed time (overtime cases), following client guidelines.
• Manually correct authorizations that exceed the system size limit, confirming the authorization stays valid and complete so it can be submitted successfully.
• Review and remove unwanted or irrelevant authorizations and documents from case files, making sure no required document is lost and no unrelated PHI remains on the case.
• Add special instructions to cases that are missing them, so case handling stays consistent.

Compliance and Quality

• Follow HIPAA and data privacy guidelines when handling PHI.
• Manually verify records, authorizations, and client communications before taking action, to prevent PHI exposure and processing errors.
• Meet daily productivity targets, turnaround times, and quality audit standards.
• Coordinate with the onshore team on process updates, exceptions, and client-specific requirements.

Skills and Qualifications

• Any graduate. Experience in US healthcare, APS retrieval, or medical records is preferred.
• Strong spoken and written English for provider calls and client emails.
• Strong attention to detail and sound judgment for reviewing orders, authorizations, and case documents.
• Understanding of PHI sensitivity and HIPAA compliance, or the willingness to be trained on it.
• Basic computer skills, and comfort working across multiple tools and dashboards.
• Able to work US night shifts and manage high daily case volumes without compromising accuracy.