Introduction to UnitedHealthcare
At UnitedHealthcare, we are driven by a profound mission to simplify the healthcare experience, create healthier communities, and remove barriers to quality care. Our work has a direct and profound impact on the lives of millions of people, making their lives better. We are committed to building the healthcare system of tomorrow, one that is more responsive, affordable, and equitable. If you are ready to make a difference and start doing your life's best work, we invite you to join us.
About the Role
We are seeking an experienced and compassionate Customer Service and Claims Representative to join our team. In this role, you will have the unique opportunity to work from anywhere within the U.S., enjoying the flexibility of telecommuting while taking on challenging and rewarding responsibilities. You will be part of a team dedicated to delivering the best customer service in the healthcare industry, leveraging your customer service expertise and our comprehensive training and support to ensure your success.
Key Responsibilities
- Answer incoming phone calls from customers, identifying the type of assistance needed, and providing timely and effective solutions.
- Ask appropriate questions, listen actively, and document required information in our computer systems to ensure seamless issue resolution.
- Own problems through to resolution on behalf of the customer, either in real-time or through comprehensive and timely follow-up.
- Review and research incoming healthcare claims from members and providers, navigating multiple computer systems and platforms to verify necessary data for processing.
- Ensure the proper benefits are applied to each claim, using appropriate processes and procedures, including claims processing policies, grievance procedures, state mandates, CMS/Medicare guidelines, and benefit plan documents.
- Communicate and collaborate with members and providers to resolve issues, using clear and simple language to ensure understanding and satisfaction.
- Meet performance goals established for the position, focusing on efficiency, accuracy, quality, member satisfaction, and attendance.
Essential Qualifications
To be successful in this role, you will need:
- A High School Diploma/GED or 10 years of equivalent work experience.
- To be at least 18 years of age or older.
- 2 years of previous or current claims processing experience with UMR CPS (claims processing system), specifically as an employee of UMR.
- 1 year of customer service experience in an office or professional setting.
- Ability to complete on-the-job training during your normally scheduled 8-hour shift, Monday through Friday, between 7 am and 8 pm CST.
- Flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 7:00 pm CST, with the possibility of occasional overtime.
Preferred Qualifications
While not required, the following qualifications are preferred:
- Familiarity with medical terminology, health plan documents, or benefit plan design.
- Prior experience utilizing multiple systems/platforms while on a call with a member.
Telecommuting Requirements
To work remotely with us, you will need:
- The ability to keep all company-sensitive documents secure.
- A dedicated work area that is separated from other living areas and provides information privacy.
- A location that can receive a UnitedHealth Group-approved high-speed internet connection or an existing high-speed internet service.
Soft Skills
We are looking for individuals with:
- Demonstrated ability in using computer and Windows PC applications, including strong keyboard and navigation skills and the ability to learn new computer programs.
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner, identifying and exceeding customer expectations.
- Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member.
- Flexibility to customize approach to meet all types of member communication styles and personalities.
- Proficient problem-solving approach to quickly assess the current state and formulate recommendations.
- Proficient conflict management skills to resolve issues in stressful situations and demonstrate personal resilience.
- Ability to multi-task and understand multiple products and multiple levels of benefits within each product.
- Ability to work regularly scheduled shifts within our hours of operation, including the training period, with flexibility to adjust daily schedules and work overtime as needed.
Career Growth Opportunities and Learning Benefits
At UnitedHealth Group, we are committed to your growth and development. You will have access to comprehensive training programs, ongoing education, and opportunities to advance your career within our organization. Our goal is to provide you with the tools and support necessary to excel in your role and achieve your professional goals.
Work Environment and Company Culture
We pride ourselves on a work environment that is inclusive, supportive, and focused on making a positive impact on the lives of our members and the communities we serve. Our company culture values diversity, equity, and inclusion, recognizing that these elements are essential to creating a healthier atmosphere for everyone.
Compensation, Perks, and Benefits
We offer a competitive compensation package, including a salary range of $16.54 - $32.55 per hour for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, or Rhode Island residents. Additionally, you will be eligible for a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution, subject to eligibility requirements.
Conclusion
If you are passionate about delivering exceptional customer service, have a strong desire to make a difference in the lives of others, and are looking for a challenging and rewarding career opportunity, we encourage you to apply for the Experienced Customer Service and Claims Representative role with UnitedHealthcare. Join our team and start doing your life's best work.
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