Note: The job is a remote job and is open to candidates in USA. UnitedHealth Group, through its Optum organization, delivers technology-aided care and resources that help people live healthier lives. The Senior Customer Service Representative supports providers and customers by resolving inquiries related to claims, authorizations, and IPA functionality, while coordinating with physicians, health plans, and IPA staff. The role also documents issues, interprets contracts, trains new staff, and promotes high-quality customer service.
Responsibilities
- Occasional shadowing/training of newly hired staff
- 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 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 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
Skills
- High School Diploma / GED OR equivalent work experience
- Must be 18 years of age OR older
- 1+ years of experience in customer service role in a medical environment
- 1+ years of experience in Medicare and HMO environment
- Ability to identify confidentiality and its requirements (HIPAA)
- Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Ability to type 40 - 50 words per minute
- Ability to work full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30 am - 4:00 pm PST. It may be necessary, given the business need, to work occasional overtime
- Reside within the state of California
- 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
- Strong organizational skills
- Excellent communication and presentation skills
- Good grammar, voice and diction
- Ability to retain composure
- 2+ years of office experience working within scheduling or training in the medical field setting
- 1+ years of claims processing or claims customer service experience
- 1+ years of authorization/referral processing experience
- Knowledge of standard billing practices
- Ability to interpret provider and health plan contracts
Benefits
- Remote work in California
- Weeks of on-the-job training
- Career development opportunities
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Company Overview