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Are you looking for a chance to get your foot in the door with a great company? You’ve found it here. Already one of the world’s leading health care companies, UnitedHealthcare is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. Here, you’re not just working. You’re making great things happen for the people who rely on us for health care across the United States. You’re part of an elite team that’s equipped with the best tools and resources, the most thorough training and learning opportunities and a mission that can inspire you every day. This is your chance to do your life’s best work. (SM)
As a Claims and Customer Service Specialist, you’ll play a critical role in creating a quality experience that impacts the financial well-being of our members. You will be the expert problem solver as you work to quickly identify, analyze and resolve issues in a fast paced environment. This is your chance to take your career to the next level as you support teams by reviewing, investigating, negotiating, and processing claims. Bring your listening skills, emotional strength and attention to detail as you work to ensure every claim has a fair and thorough review.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (7:00am to 6:00pm). It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 10701 West Research Drive, Wauwatosa, WI 53226.
- Answer incoming phone calls from members and health care providers (i.e. physician offices, clinics) and identify the type of assistance the caller needs (i.e. benefit and eligibility, billing and payments, and/or explanation of benefits (EOBs)
- Review and research incoming claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing (e.g. verify pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
- Communicate and collaborate with members and providers to resolve claims errors/issues, using clear, simple language to ensure understanding.
- Resolve issues on the first call, navigate through the appropriate computer system(s) to identify the current status of the issue and provide appropriate response to caller. Deliver all information and questions in a positive, conversational and compassionate manner to facilitate developing a relationship with the caller, while providing the best customer service experience possible
- Constantly meet established productivity, schedule adherence, and quality standards
- Processes claims according to specified procedures and standards, meeting all position production and quality standards.
- Recognizes when to refer complicated claim situations to the various areas, outside firms and organizations. Submits and monitors claims referred to internal support units.
- Handles complex claim situations. Analyzes and resolves problems from customers and providers. Selects and explains the best solution for the problem.
- Project work as assigned
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
- Demonstrated proficiency in using Microsoft Office (Outlook, Word & Excel) to complete work assignments
- 1+ year of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
- An education level of at least a high school diploma or GED OR equivalent years of work experience
- Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Bilingual in both English and Spanish
- 1+ year experience processing medical, dental, prescription or mental health claims
Physical Requirements and Work Environment
- Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.SM