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About worksphere
worksphere is a fast‑growing, technology‑driven leader in the health‑insurance and workers’ compensation space. Recognized as an Inc. 500 company, we process more than 200,000 insurance claims each year for a diverse portfolio of national and regional carriers, third‑party administrators, managed‑care organizations, employers, and pharmacy benefit managers. Our mission is to deliver precise, timely medical determinations that help our clients manage risk, control costs, and improve outcomes for injured workers and policyholders. At worksphere, we foster a high‑performance culture where collaboration, innovation, and continuous learning are celebrated. Whether you’re joining our bustling headquarters or thriving in a remote environment, you’ll be part of a team that values integrity, empathy, and excellence.
Position Overview
We are seeking a detail‑oriented, customer‑focused professional to join worksphere as a Physician Advisory Services Customer Service Representative. In this remote, U.S.-based role, you will be the critical first point of contact for new medical case intake, ensuring accurate data entry, seamless case assignment, and proactive communication with both clients and physicians. Your work will directly impact the efficiency of our claims processing pipeline and the satisfaction of our clients and provider network.
Key Responsibilities
- New Case Intake & Verification: Receive incoming case requests, review all accompanying documentation, and verify completeness. Accurately draft each case in worksphere’s proprietary system, AccessDS, ensuring that every data field is populated correctly.
- Client Collaboration: Liaise with clients to obtain missing information, clarify referral details, and confirm that all required medical records are attached. Maintain a courteous, solution‑oriented demeanor throughout each interaction.
- Medical Document Management: Organize, sort, and create comprehensive medical document listings when required, adhering to client‑specific handling instructions and regulatory guidelines.
- Physician Assignment & Scheduling: Match each case with an appropriate physician reviewer based on geographic location, specialty, reviewer availability, jurisdictional requirements, and any client‑specified criteria. Conduct conflict‑of‑interest checks to ensure unbiased reviews.
- Case Oversight & Tracking: Monitor the progress of assigned cases, update status in the system, and proactively address any bottlenecks to meet established deadlines.
- Client Communication: Provide regular updates to clients on case status, respond to inquiries, and ensure that all required documentation is delivered promptly to the assigned physician.
- Continuous Improvement & Special Projects: Participate in process‑enhancement initiatives, contribute ideas for workflow optimization, and assist with ad‑hoc projects that support worksphere’s business objectives.
Essential Qualifications
- Education: Associate’s degree or higher is preferred; relevant coursework in health administration, business, or a related field is a plus.
- Industry Experience: Prior experience in a healthcare, insurance, or medical‑claims environment is highly desirable.
- Technical Proficiency: Strong computer literacy, including proficiency with Microsoft Office Suite, data‑entry platforms, and the ability to quickly learn new software (experience with AccessDS or similar claim management systems is advantageous).
- Communication Skills: Exceptional written and verbal communication abilities, with a talent for translating complex medical terminology into clear, client‑friendly language.
- Critical Thinking & Time Management: Demonstrated ability to prioritize tasks, meet strict deadlines, and solve problems independently.
- Typing Speed: Minimum 45 WPM with high accuracy.
Preferred Qualifications & Additional Skills
- Experience working remotely in a fast‑paced, deadline‑driven environment.
- Familiarity with workers’ compensation, disability, or auto insurance claim processes.
- Knowledge of HIPAA privacy regulations and best practices for handling protected health information (PHI).
- Certification in medical coding (e.g., CPC, CCS) or a background in medical records management.
- Fluency in a second language to support diverse client bases.
Core Competencies for Success
- Customer‑Centric Mindset: Prioritize client satisfaction and provider relationships in every interaction.
- Attention to Detail: Meticulously verify data and documentation to prevent errors that could delay case processing.
- Adaptability: Thrive in a dynamic environment where priorities can shift quickly.
- Team Collaboration: Work closely with internal teams—including claims adjudicators, IT support, and senior leadership—to ensure seamless case flow.
- Ethical Judgment: Uphold the highest standards of confidentiality and integrity when handling sensitive medical information.
Career Growth & Learning Opportunities
worksphere is committed to the professional development of its employees. As a Customer Service Representative, you will have access to:
- Structured onboarding and mentorship programs that pair you with seasoned claims professionals.
- Continuous training on emerging healthcare regulations, advanced claim‑management technologies, and best practices in provider communication.
- Clear career pathways leading to senior analyst, case manager, or supervisory roles within our Physician Advisory Services division.
- Opportunities to obtain industry certifications (e.g., Certified Professional Biller, Certified Claims Analyst) with company‑sponsored tuition assistance.
Work Environment & Culture at worksphere
Our remote workforce enjoys a flexible schedule, with two primary shift options:
- 9:30 am – 6:00 pm EST
- 10:00 am – 6:30 pm EST
Beyond flexible hours, worksphere promotes a culture of inclusion, transparency, and recognition. Employees are encouraged to share ideas, celebrate milestones, and participate in virtual team‑building events. Our collaborative platform ensures that remote team members stay connected, supported, and engaged.
Compensation, Benefits & Perks
worksphere offers a competitive salary package complemented by a comprehensive benefits suite designed to support your health, financial security, and work‑life balance:
- Health Coverage: Medical, dental, and vision plans for you and your eligible dependents.
- Life & Disability Insurance: Basic life insurance at no cost, with optional voluntary coverage for spouses and children, as well as short‑term and long‑term disability protection.
- Voluntary Benefits: Hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
- Retirement Savings: 401(k) plan with company match to help you build a secure future.
- Paid Time Off: Generous PTO accruals, paid holidays, and additional leave for personal wellness.
- Remote Work Support: Apple‑branded equipment, a media stipend for home‑office setup, and reimbursement for high‑speed internet services.
- Professional Development: Access to online learning platforms, certification reimbursement, and internal training workshops.
Physical & Technical Requirements
- Ability to sit for extended periods while performing computer‑based tasks.
- Occasional lifting or bending may be required to manage physical documents, though the role is primarily virtual.
- Reliable high‑speed internet connection and a dedicated, quiet workspace are essential for uninterrupted performance.
Why Join worksphere?
At worksphere, you will be part of a purpose‑driven organization that values every employee’s contribution to the broader mission of improving health‑care outcomes. Our commitment to innovation, employee well‑being, and community impact makes us an employer of choice for professionals who want to make a tangible difference while advancing their careers.
Ready to Make an Impact?
If you are a proactive, detail‑oriented individual with a passion for delivering exceptional service in the healthcare‑insurance arena, we invite you to apply today. Join worksphere and help shape the future of medical claims management while enjoying a supportive, growth‑focused work environment.
Apply now and become a vital member of the worksphere team!
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