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Customer Service Representative

Company: UnitedHealth Group
Location: Denver
Posted on: November 26, 2022

Job Description:

UnitedHealth Group is hiring Customer Service Representatives! Benefits:

  • Competitive compensation
  • UHG paid training
  • UHG paid state licensing
  • Medical/dental/vision insurance A Customer Service Representative is a single point of contact for consumers for all things related to health and wellness benefits. A Health Care Advisor helps members navigate the health care system; including helping with claim and benefits questions, helping members find quality doctors and schedule appointments; connecting consumers with health and wellness resources; and coaching members to make better health choices by providing education. A Health Care Advisor creates an ongoing and lasting impression of the Optum consumer experience. Responsibilities:
    • Handle inbound and outbound calls with an emphasis on excellent customer service in a call center environment
    • Take responsibility for addressing member issues, questions, concerns, and see them through to resolution
    • Respond to members and providers in a polite and courteous manner, with patience, empathy, care, compassion, and sincerity in voice tone and pace
    • Assist members with medical and pharmacy benefits, medical plan overview, behavioral health inquiries, claims, provider search and prior authorization
    • Provide member education on HSA, FSA, HRA, and other financial accounts
    • Serve as a Health Care Advisor, going above and beyond for consumers, creating a memorable consumer experience, and providing expert, proactive service to members by: Finding creative ways to do more than what the member expects; Delighting each member by meeting their unexpressed needs; Leaving each person feeling confident and cared for
    • Provide services such as:
      • Education to help simplify the healthcare system and validate members understanding of next best actions
      • Advise members in choosing healthcare providers that meet and exceed consumer needs
      • Educate members on clinical and wellness resources they can take advantage of to manage a health condition/disease or reach a wellness goal
      • Provide education to members to assist in understanding benefits, terminology, claim resolution and Explanation of Benefit interpretation
      • Serve as an advocate by responding to, resolving, and escalating complex claim issues with internal and external resources
      • Initiate telephone calls to internal sources, membership, providers, and other claim payers to gather data and determine resolution to claim issues
      • Refer qualified members into Wellness and clinical programs
      • Solve problems systematically, using sound business judgment, and following through on commitments
      • Consistently meet established productivity, schedule adherence, meeting metric expectations, and quality audit standards
      • Work with cross carries to ensure member follow up and resolution (cross carrier functions)
      • Work with providers and plans to help ensure critical info is being relayed timely between the plan and the provider
      • Support multiple clients and their individual expectations
      • Help establish patient appointments for the first time visit to the PCP
      • Provide community resources once internal resources have been exhausted (e.g. Financial assistant programs, Medical assistant program resources)
      • Work with Network management to ensure panel request are up to date and when providers are not confirming to the contract (e.g. balance billing)

Keywords: UnitedHealth Group, Denver , Customer Service Representative, Hospitality & Tourism , Denver, Colorado

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