Note: The job is a remote job and is open to candidates in USA. Optum is a global organization that delivers care aided by technology to help millions of people live healthier lives. The Senior Clinical Administrative Coordinator handles inbound and outbound customer calls, researches healthcare claims, applies appropriate benefits, and resolves member and provider issues while meeting performance goals.
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
Skills
- Candidate needs to have Customer Service experience, can listen and type at the same time
- This position is full-time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 7:00 pm CST
- High School Diploma / GED
- Must be 18 years of age OR older
- 1+ years of experience in customer service
- Ability to work regularly scheduled shifts within our hours of operation of 7:00 am - 7:00 pm CST 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
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
- Preferred Healthcare benefits experience
- 1+ years of experience in an office setting, call center setting OR phone support role
Benefits
- National Remote; flexibility to telecommute from anywhere within the U.S.
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- 1 - 2 weeks of paid on-the-job training
- Career development opportunities
Company Overview