Customer Service Representative

hace 4 semanas

Xico, México Ust A tiempo completo

About UST HealthProof

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.

Job Summary

We are seeking a highly skilled and experienced Customer Service Associate to join our team. As a Customer Service Associate, you will provide exceptional customer service to our health plan customers via inbound call center operations. You will be responsible for receiving and responding to inbound phone calls for customer assistance, mentoring new call center agents, and supporting the improvement of peers.

Key Responsibilities

  • Receive and respond to inbound phone calls for customer assistance
  • Be a peer mentor and support the improvement of peers
  • 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 primary payor systems
  • Maintain a full comprehensive understanding of covered benefits, coding and reimbursement policies and contracts

Requirements

  • 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 healthcare 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
  • Excellent verbal and written communication skills

What We Believe

We're proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we've been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do.

Our Values

  • Humility: We will listen, learn, be empathetic and help selflessly in our interactions with everyone.
  • Humanity: Through business, we will better the lives of those less fortunate than ourselves.
  • Integrity: We honor our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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