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Customer Service Representative Lead - Secaucus, NJ

UnitedHealth Group Secaucus, NJ
  • Posted: September 19, 2019
  • Full-Time

OptumCare is
succeeding at helping people live healthier lives by taking a different
approach to health care. OptumCare
uses a common sense approach, focused on avoiding jargon, finding more
efficient ways to operate, and providing great, in-the-moment service. We
provide that service by making sure serving our patients and providers is
always the first priority. Each department works from the same central idea:
"How does this affect the service we provide?" Because of the extreme
commitment to service, OptumCare
focuses on recruiting passionate employees who will take advantage of being
empowered to provide the highest level of service at each and every step.

Local Care Delivery (LCD) is a network of health care providers in local markets
whose mission is to help providers deliver the most effective and compassionate
care to each patient they serve. Local Care Delivery's primary focus is on
doing the right things for patients, physicians, and the community. It uses an
innovative service model focused on measuring what matters and increasing
efficiency and performance while providing the highest level of customer service.
This model allows LCD to make a difference each day by delivering highly
personal, customized care management to its patients.

Primary Responsibilities:

  • Accountable forproblem resolution of customer issues and to communicate resolution toappropriate parties
  • Available, asscheduled, to respond to calls from customers regarding claims payments,benefits, eligibility, and certification issues
  • Investigate issuesand document steps taken to achieve resolution
  • Manage resolution ofissues through contact with the claims department, case management, andexternal payers ultimately achieving a positive outcome
  • Investigate andhandle retro-certification activities, as required for resolution of customerissues
  • Respond to customersregarding status of formal complaints or appeals
  • Handle and resolveescalated issues when appropriate
  • Meet departmentalstandards for production and quality
  • Meet departmentalstandards for schedule adherence
  • Participate intraining and self-development opportunities when appropriate
  • Demonstratea cooperative, positive attitude in the workplace
  • Demonstrate a basic knowledge of managed healthcare andclaims
  • Perform all otherduties as deemed appropriate to provide customer service
  • Answer and respond to member inquiries regardingEffective and efficient handling of incoming call/claim issues
  • Ability to review and handle appropriately:
  • Network and member contract questions
  • Claims Issues
  • Pharmacy/vision/dental/chiropractic issues
  • Coordination of Benefits (Medicare Estimation and when isapplies)
  • Adhere to quality improvement initiatives
  • Special projects as required
  • Resolvemember service inquiries related to:
  • Medicalbenefits, eligibility and claims
  • Financialspending accounts
  • Pharmacybenefits, eligibility and claims
  • Correspondencerequests
  • Educatemembers about the fundamentals of consumer-driven health care including:
  • Managinghealth and well being
  • Maximizingthe value of their health plan benefits
  • Choosinga quality care member
  • Premiummember education and steerage
  • Ownproblem through to resolution on behalf of the member in real time or throughcomprehensive and timely follow-up with the member
  • Helpmembers navigate,, and other UnitedHealthGroup websites
  • Researchcomplex issues across multiple databases and work with support resources toresolve member issues
  • Assistmembers with member appointment scheduling
  • Connectmembers with internal specialists for assistance when needed
  • Partnerwith others to resolve escalated issues
  • Provideeducation and status on previously submitted pre-authorizations orpre-determination requests.
  • Assist Supervisor team with escalated issues
  • Mentor new hires and existing staff in the efficient useof call handling best practices designed to ensure accurate and consistent callresponses
  • Launch outbound calls as appropriate
  • Provides targeted coaching to frontline Service Advocates(side-by-side)
  • Coaches staff on call handling techniques to effectivelyConnect, Help, and Solve
  • Serveas an expert by answering questions and accepting escalated calls from theteam
  • Assistin researching and responding to complex customer calls within currentturnaround standards
  • Providesfeedback to the team with guidance from the Supervisor
  • Supportsnew team members to help make a successful transition to the floor
  • Tracksand trends issues from the floor (technical clarification, systems)
  • Makesrecommendations on process improvements
  • Acceptsinbound calls to ensure continued superior performance with metrics
  • Identifiespotential gaps in knowledge based on performance results. Filtersfeedback and documentation for curriculum revisions to training
  • Workswith the Supervisor and team to tackle performance opportunities
  • Trackstraining needs or other areas noted for improvement, and sends documentation toappropriate area
  • Executesspecial projects as required (i.e. audits, project pilots, etc)

You'll be rewarded and recognized for your performance in
an environment that will challenge you and give you clear direction on what it
takes to succeed in your role as well as provide development for other roles
you may be interested in.
Required Qualifications:
  • High School/GED (or higher)
  • Ability to type 30+ WPM is required
  • 2+ years of call center and/or customer serviceexperience
  • Ability to work in a Windows based environment
  • Available to work 40 hours per week anytime within theoperating hours of the site
  • Successful completion of United Health Care OperationsCCP new hire training and demonstrated proficiency required
Preferred Qualifications:
  • Associate degree or equivalent experience
  • Bilingual English/ Spanish
  • Knowledge of HMO/PPO/Medicare Plans/benefits and medicalterminology
  • Healthcare experience
Physical Requirements and Work Environment:
  • Frequent speaking, listening using a headset, sitting,use of hands/fingers across keyboard or mouse, handling other objects, longperiods working at a computer
  • Service center environment with moderate noise level dueto Representatives talking, computers, printers, and floor activity
  • Able to lift 50lbs
  • Push and pull wheelchairs

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Key words: customer service representative, customer ser

UnitedHealth Group


Secaucus, NJ
07094 USA

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