CUSTOMER SUPPORT

Our customer agents act as liaisons between the client and Simonpietri Hemisferica’s departments and business units. As part of our health business initiatives we offer support of the utmost quality and responsiveness. Our aim is to optimize performance and maximize profit and return on investment. Our customer support agents are not limited to one specific area. They participate in multi-disciplinary and inter-departmental teams assisting our clients with tasks that range from auditing to plan design. Usual teams include members from Hemisferica’s provider support, marketing, finance, eligibility, claims, IT and compliance departments.

How we help

• Plan Design and updating

• Direct and open communication via email and telephone with our client’s respective contacts

• Process payment requests

• Reporting

• Utilization Summary Report

• Historical Utilization Statistics

• Expenditure per class or level of treatment

• Service Denied

• Patients by provider

• Top Providers (by amount and occurrence)

• Invoice listing (member/avg. amount)

• Invoice listing (member/avg. occurrence)

• Production per occurrence / period / provider YTD

• TVU

• Profile Count by provider

• Financial

• Group report by member

• Group report by provider

• Member / group / service date

• Member / group/ detail

• Lag report

• Check register

• Claims

• Aging

• Check register

• Printed checks

• Check history

• Claims filed

• Stop payments

• Payment reversal

As Customer Support Agents

• We identify and report system bugs. Once addressed we conduct the necessary diagnostics to assure compliance and quality assurance.

• We are in constant communication with the claims processing department as we are aware of the importance collaboration for precise claim adjudication.

• We channel our Call Center referrals to the respective managers and supervisors.

• We also evaluate the audits to tasks performed by our claims, analysis and IT personnel.