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Customer Service Representative

UnitedHealth Group
San Rafael, CA
  • Expired: 25 days ago. Applications are no longer accepted.
Job Description

UnitedHealth Group is hiring Customer Service Representatives!


  • 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.


  • 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)


  • High School Diploma / GED (or higher)
  • 1+ years of experience within the Healthcare Field, Advocacy Service, Customer Service, and/or Call Center Services, Sales, Hospitality
  • 1+ years of experience with insurance, benefits, and claims
  • Proficiency with Microsoft Office – Microsoft Word (creating, editing, saving, formatting), Microsoft Excel (create and edit spreadsheets), Microsoft PowerPoint (create, edit, and format presentations) and Microsoft Outlook (compose and respond to email)
  • Ability to work any of our 8-hour shift schedules during our normal business hours of (Monday – Friday 8:00am – 11pm EST. It may be necessary, given the business need, to work occasional overtime including Saturdays
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.

Preferred Qualifications:

  • Associate degree (or higher) in related field
  • Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer applications and apply their use while on the phone
  • Experience with medical or health terminology
  • Multi-lingual proficiency (e.g. English/Spanish)
  • Inside sales

Careers at UnitedHealth Group. We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these select few, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you're empowered to be your best. We encourage you to take risks. And we offer a world of rewards and benefits for performance. We believe the most important is the opportunity to do your life's best work.

Company Description
A distinctively diversified health and well-being company headquartered in the United States, and a leader worldwide in helping people live healthier lives and helping make the health system work better for everyone.

UnitedHealth Group


San Rafael, CA



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