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Customer Service Rep - San Antonio, TX more...
Location:San Antonio, TX
Company:OptumCare
First posted:June 08, 2017
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Don't wait to apply we have training classes starting soon that are designed to set you up for success!

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 Advocate 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)

The Customer Service Specialist provides expert service to providers and patients who have claims related questions by promptly responding to their concerns in a timely manner. In addition, this position will resolve payment / adjudication questions at the time the call is received; explaining calculation methodology, contract terms, procedures, etc.
To learn even more about this position, hear from other Customer Service Advocates. Click here to watch a short video about the job: (please use the apply button below)
(Note: these videos are labeled with our internal job title of Health Advisor)

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.
Primary Responsibilities:

Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence

Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider

Intervene with care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed

Assist customers in navigating (please use the apply button below) and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient

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 efficiency, call quality, customer satisfaction, first call resolution and attendance

Clearly communicates claims status, payment methodology, contract terms, procedures, etc. to customer

Identifies trends in errors or inquiries and reports these to appropriate personnel

Informs and assists callers with the claims appeals process, if necessary

Develops a tracking system to ensure that all priority issues are handled within established time frames and proactively notifies customers of anticipated delay

Answer customer service lines promptly and professionally and maintain at least a 95% response time

Demonstrate excellent customer service by determining the reason for the call, acknowledging the callers concerns and resolve concerns and/or explain action to be taken within the expected time line for resolution

Performs research on complex claim inquiries and expertly re-examines claims

Serves as a resource to medical group staff, network providers, health plan representatives and claims staff

Presents a pleasant voice to all callers, regardless of the stressful nature of the situation

Performs all other related duties as assigned

Required Qualifications:

High School Diploma or GED OR 10 years of equivalent working experience

2 years of experience in a health care or managed care customer service environment

1 year of Customer service experience

Demonstrated 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)

Excellent verbal communication skills and customer service skills

Working knowledge of Microsoft Office applications including Excel, Access and Word

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, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed

All new hires will be required to successful complete the UnitedHealthcare Operations Customer Service Advocate training classes and demonstrate proficiency of the material
Preferred Qualifications:

Associates Degree in Business or Information Systems

1-2 years of experience working in a Healthcare claims environment

Knowledge of HCFA guidelines and Medicare claims payment rules and claims policies and procedures

Health care experience
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's 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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