Customer Service Associate

hace 1 mes

Guadalajara, Jalisco, México UST HealthProof A tiempo completo
Role Description

Customer Service Associate

Associate III – BPM

Who We Are

Founded in 2016, we've become a trusted and valued partner for health plans and providers. We offer a modern integrated ecosystem of healthcare operations, processes, and products, with inherent scalability, efficiency, and predictable outcomes. Our BPaaS delivery solutions work behind the scenes to manage our customers' complex admin operations, giving them elbow room to focus on their members' needs and well-being.

Bending cost curves, guaranteeing outcomes, finding paths through roadblocks – that's our way of life. Our customers count on us to safely navigate them through deadlocks. We have a strong global presence and a dedicated workforce of 4000+ people spread across the world.

Our brand is built on strong foundations of simplicity, honesty, and leadership, and we stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

You Are

Reporting to the Customer Service Manager, the Customer Service Associate will provide exceptional customer service to the UST customers via inbound Call Center Operations. Associate will mentor new call center agents as well as support the improvement of peers. The service center will be open from 8am-6pm CST USA and will occur related schedules.

The Opportunity

  • Receive and respond to inbound phone calls for customer assistance
  • Be a peer mentor
  • Take escalated calls and issues as experience dictates
  • Respond to outbound phone call requests
  • Document all calls in ticketing and tracking systems
  • Respond to customer inquiries and provide data to customers within a required time frame
  • Act as liaison between claims department and providers
  • Research customer claims in the primary payor systems
  • Ensure highest level of customer service on every call

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What You Need

  • High school degree required; Bachelor's degree preferred with three (3) plus years of relevant professional experience in Healthcare claims operations for a large national/regional or Blues health plan or insurance company and/or TPA.
  • Previous Health Care Call Center/Customer Service Experience.
  • Desired Skills include: Knowledge of physician practice and hospital coding, billing and medical terminology
  • Experience with UB/Institutional (UB04); Professional (CMS1500) claims and HIPAA-compliant EDI formats for claims related exchanges. Understand CMS guidelines for claims processing.
  • Must be able to work with minimal supervision.
  • Maintain a full comprehensive understanding of the covered benefits, coding and reimbursement policies and contracts.
  • Excellent verbal and written communication skills.
  • Attention to detail and problem solving skills
  • Proficiency with MS Office applications, especially Word and Excel.

What We Believe

At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serves as a compass guiding every action and decision.

Guiding Principles

These principles illuminate the path of 'how' we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.

Integrity

Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.

People-Centricity

Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.

Simplicity

Simplifying complexity underlines everything we do - this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.

Leadership

Taking ownership is about taking initiative, being in-charge and driving things to completion. It's a brave choice to 'own' all aspects of our work, ensuring we take full responsibility for everything we handle.

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members' well-being.

#Healthproof

Skills

Healthcare,Call Center,Call Center Operations

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