Job Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)

Responsible for representing the organization and functioning as a key communicator for the organizations members and providers. Educates and informs customers of organizations programs and services. Promotes company's commitment to superior customer service. Proactively and reactively seeks appropriate solutions to potential and existing service issues. Identifies root cause issues and works diligently and cooperatively to minimize or eliminate issues.

If you are located within 30 miles of Onatrio, CA you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

* Receives and records customer concerns via phone. Acts to resolve concerns in accordance for corporate guidelines and standards for all areas of claims, authorizations and IPA functionality
* Functions as liaison between member, physician, health plan, and IPA staff
* Ability to interpret provider and health plan contracts to ensure accurate responses to calls
* Log issues into the Customer Service Tracking database that require resolution and/or follow-up
* Plan and organize workload to ensure efficient and timely resolution of issues
* Respond to callers with the resolution of issues in a timely manner in accordance with the guidelines set by the department
* Participates in senior outreach program via telephone with approved script
* Participates in telephonic surveys as required by management
* Follow and support the guidelines set by the department and organization to ensure overall goals are met
* Maintain minimum standards for the department for quality and quantity of calls received
* Foster interpersonal relationships, showing empathy and understanding towards staff, protecting individual self-esteem. Understand own impact on others; interact effectively with peers, subordinates, and supervisors
* Any other assigned duties as delegated by the Customer Service Supervisor

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

* High school diploma or a general education degree
* 2+ years claims processing experience
* 1+ years experience in Medicare and HMO environment
* 1+ years of previous customer service experience
* 6+ months authorization/referral processing experience
* Knowledge of standard billing practices
* Ability to interpret provider and health plan contracts
* PC proficient in a windows environment to include Microsoft word, Outlook and Excel
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

* Excellent communication skills
* Good grammar, voice and diction
* Strong organizational and prioritization skills
* Able to represent the company in a professional and positive manner
* Ability to retain composure in stressful situations
* Ability to de-escalate potential volatile situations
* Ability to identify confidentiality and its requirements (HIPAA)
* Strives to be a team player
* Must have excellent, writing, punctuation, grammatical and spelling skills

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Customer Service Representative, call center, customer service rep, Ontario, CA, California