Customer Service and Claims Representative, UnitedHealth Group
Primary Responsibilities:
Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan
documents/certificates)
Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
Required Qualifications:
High school diploma / GED (or higher) OR 10+ years of equivalent working experience
All new hires will be required to successfully complete the Customer Service training classes and demonstrate proficiency of the material
Telecommuting Requirements:
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Ability to keep all company sensitive documents secure (if applicable)
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Preferred Qualifications:
1+ years prior experience in an office setting, call center setting or phone support role
Soft Skills:
Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner, consistently meeting commitments)
Demonstrated 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
Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed
