Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The Customer Service Associate serves as a primary point of contact for healthcare providers, ensuring timely, accurate, and empathetic resolution of inquiries related to bill review, payment status, and claims processing.
Responsibilities
- Serve as initial point of contact for provider inquiries, demonstrating professionalism, empathy, and a commitment to resolution
- Respond to incoming provider calls with a focus on understanding concerns related to bill review, payment status, and claims processing
- Research complex issues across multiple systems and departments to identify root causes and determine appropriate resolutions
- Collaborate with internal teams (e.g. Billing, Bill Review, Finance) to resolve provider issues efficiently and accurately
- Take ownership of cases from intake to resolution, ensuring timely and thorough follow-up and provider satisfaction
- Support manager in identifying trends in provider inquiries and escalate systemic issues or process gaps to leadership
- Support continuous improvement initiatives by providing feedback on provider pain points and workflow inefficiencies
- Support team development by sharing best practices and assisting with informal training
- Maintain up-to-date knowledge of billing guidelines, payment policies, and system workflows to ensure accurate and informed responses
- Document all interactions and resolutions in CRM system in accordance with standard operating procedures and audit standards
- Meet department standards for productivity, including average calls per hour, average handling & wrap up time, abandoned and rejected call stats and passing QA scores
- Comply with and adhere to all regulatory compliance areas, policies and procedures and best practices
- Understand and comply with all HIPAA & SOC2 requirements necessary in working with designated PHI
- Perform additional support functions as needed
- Maintain reliable and predictable attendance during scheduled work hours
- Adhere to Company policies and procedures on attendance, including requests for planned time off, reporting sickness, start time and break times
Skills
- Minimum 1 year of experience in a high-volume contact center within a healthcare or medical billing environment
- Proven ability to own and resolve complex inquiries independently, including escalated or sensitive provider issues
- Strong focus on first-call resolution, with the ability to assess, troubleshoot, and resolve issues without unnecessary handoffs
- Skilled in de-escalating tense or frustrated interactions with professionalism, empathy, and confidence
- Demonstrated ability to navigate multiple systems and synthesize information to provide accurate, timely responses
- Experience collaborating cross-functionally with internal departments to resolve multi-layered issues
- Excellent written and verbal communication skills, with the ability to tailor messaging to diverse audiences
- Excellent organizational and prioritization skills, with ability to multi-task; strong problem solving and decision-making skills
- Excellent computer skills (e.g., Outlook, Teams, to be trained on proprietary software); standard office equipment including phones, scanners, laptop/PC, copiers, various computer programs, etc. Proficient in contact center software and telephony systems
- High level of attention to detail, accuracy, and documentation quality
- Ability to support junior team members, share best practices, and contribute to a positive team culture
- Proficiency in Microsoft Office Suite (Outlook, Teams, Excel, Word) and CRM platforms
- Commitment to compliance standards, including HIPAA, SOC2, and internal IT security protocols
- Able to cooperate and work cohesively with all co-workers, management, and external customers. Able to plan and complete job duties with minimal supervisory direction, utilize sound judgment, tact, diplomacy, and compassion in verbal and written communication
- Ensure confidentiality of all data, including injured worker's demographics, employee, and operations data
- Able to complete requirements for in-service training
- Ability to work at a fast pace in a rapidly changing environment; high level of flexibility and ability to adapt to the changing needs of the business
- Self-starter, ability to work with minimal supervision
- Familiarity with medical terminology desired
- Experience in workers' compensation billing is preferred but not required
Benefits
- Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
- Financial incentives– Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.
- Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.
- Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.
- Learning and development: One of Paradigm’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.
Company Overview
Paradigm achieves leading clinical and financial results for catastrophic and complex claims. It was founded in 1991, and is headquartered in Walnut Creek, California, USA, with a workforce of 1001-5000 employees. Its website is http://www.paradigmcorp.com/.