Experienced National Remote Customer Service and Claims Representative - Delivering Exceptional Healthcare Experiences through Compassionate Support and Effective Claims Processing

Introduction to UnitedHealthcare

At UnitedHealthcare, we are driven by a profound mission to simplify the healthcare experience, foster healthier communities, and dismantle barriers to quality care. Our work has a direct and profound impact on the lives of millions, striving to make healthcare more responsive, affordable, and equitable for all. If you are ready to embark on a journey that makes a tangible difference in people's lives, we invite you to join us in building the healthcare system of tomorrow. This is your opportunity to do your life's best work.

About the Role

We are seeking an experienced and compassionate Customer Service and Claims Representative to join our team. This role is not just about providing customer service; it's about delivering exceptional healthcare experiences that improve lives. You will be the voice of our organization, providing support, answering questions, and resolving issues for our members and their families. Your role will be critical in ensuring that every interaction with our customers is met with empathy, understanding, and a commitment to excellence.

Key Responsibilities

• Answer incoming phone calls from customers, identifying the type of assistance needed, whether it be related to benefits and eligibility, billing and payments, authorizations for treatment, or explanations of benefits (EOBs).
• Ask appropriate questions, listen actively to identify specific questions or issues, and document required information in our computer systems.
• 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 that 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.
• Meet performance goals established for the position in areas such as efficiency, accuracy, quality, member satisfaction, and attendance.

Qualifications and Skills

To excel in this role, you will need a combination of skills, experience, and personal qualities that align with our mission and values.

Required Qualifications

• High School Diploma / GED or 10 years of equivalent work experience.
• Must be 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.
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 7:00 pm CST, with flexibility to work occasional overtime as needed.

Preferred Qualifications

• 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

• Ability to keep all company-sensitive documents secure.
• Required to have a dedicated work area 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.

Soft Skills

• 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, including the ability to resolve issues in stressful situations and demonstrate personal resilience.
• Ability to multi-task as well as 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 the daily schedule and work overtime as needed.

Career Growth and Learning Benefits

At UnitedHealth Group, we are committed to the growth and development of our employees. You will have access to comprehensive training programs, career advancement opportunities, and a supportive environment that encourages learning and innovation. Our goal is to ensure that you have the tools and resources needed to excel in your role and achieve your career aspirations.

Work Environment and Company Culture

We pride ourselves on a work environment that is inclusive, diverse, and respectful. Our company culture values empathy, integrity, and a commitment to excellence. We believe that by working together and supporting each other, we can achieve great things and make a meaningful difference in the lives of our customers and communities.

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, among other benefits.

Conclusion

If you are passionate about delivering exceptional customer service, have a strong desire to make a difference in people's lives, and are looking for a challenging and rewarding career opportunity, we encourage you to apply for this role. As a Customer Service and Claims Representative at UnitedHealthcare, you will be part of a team that is dedicated to improving the healthcare experience for millions of people. Join us in our mission to build a healthier future for all.