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You want more challenge. You want more opportunity. Even more, you want the chance to make an impact the lives of others. We want more people like you. When you join us as a Customer Service Representative for UnitedHealthcare, you'll have the opportunity to make a difference in the lives of our health plan members each day as they look to you as their trusted advisor and advocate. You'll be empowered to compassionately deliver an exceptional experience to between 50 to 70 callers per day always remembering that there is a real person on the other end of the phone who is looking for help, guidance, and support. You'll help them make informed decisions about their care services by answering their questions, resolving their issues or helping them enroll in and / or select a health plan. You'll do this by developing and maintaining a productive relationship and interaction with all callers, while providing personalized, and consultative education and information. Here, you'll join us on a mission to deliver the best customer service in the health care industry. Period. Your compassion and customer service expertise combined with our support, training and development will ensure your success. This is no small opportunity. This is where you can bring your compassion for others while doing your life's best work.(SM)
To learn even more about this position, hear from other Customer Service Representatives. Click here to watch a short video about the job: http://uhg.hr/customerserviceadvocate1 (Note: these videos are labeled with our internal job title of Health Advisor)
Work with vendors to review and reprice pharmacy bills according to regulatory guidelines and in light of any client-specified special instructions, checking potential duplicates, reading notes sent electronically from adjusters and reading medical notes when necessary to make decisions on relatedness based on claim notes and diagnosis codes
Communicate with pharmacies, providers and physician - dispensed networks to assist in real-time with transaction processing, liaising with adjusters to determine patient eligibility, identify and resolve processing issues and proactively minimize blocked transactions
Research and reevaluate previously audited claims returned by the provider for additional consideration; corresponds with carriers and providers via email and telephone and correct the billing as necessary
Understand rules and regulations for each carrier or network provider, working with leadership to develop new partner - specific guidelines and data to increase network penetration
Implement temporary contracts for and build relationships with non-contracted pharmacies
Follow up with pharmacies, carriers and networks on transaction / bill processing, establishing a point of contact to maintain a strong relationship and improve customer care and satisfaction.
Correct and ensure accurate data for billing and state reporting
Respond to customer inquiries concerns and review claims for any special instructions
Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow - up with the member
Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
Provide education and status on previously submitted pre - authorizations or pre - determination requests
Meet the performance goals established for the position in the areas of: queue inventory, productivity, call quality, customer satisfaction and attendance
Must initiate federal clearance within first 90 days
Positions in this function are responsible for providing expertise and customer service support to members, customers, and/or providers. Direct phone - based customer interaction to answer and resolve a wide variety of inquiries. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
High School Diploma / GED or higher
1+ years Customer Service experience
1+ years of Pharmacy or Workers Compensation claims experience
Experience using MS Excel to open, edit, sort / filter and save documents
Experience using MS Word to open, edit and save documents
Ability to work regularly scheduled shifts within our hours of operation of 8am-5pm, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and / or weekends, as needed
Associates Degree or higher
Health care experience
Ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manners, consistently meeting commitments)
Ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
Proficient problem solving approach to quickly assess current state and formulate recommendations
Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
Flexibility to customize approach to meet all types of member communication styles and personalities
Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilience
All new hires will be required to successful complete the UnitedHealthcare Operations Customer Service Advocate training classes and demonstrate proficiency of the material
There are several steps in our hiring process it's a thorough process because we want to ensure the best job and culture fit for you and for us. In today's ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application / job questions). Once you submit your resume, you'll receive an email with next steps. This may include a link for an on-line pre - screening test that we ask you to complete as part of our selection process. You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail.
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your lifes best work.SM
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.
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