Great jobs start with great training and our next class is starting soon. Apply today.
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.
This position is full-time (40 hours/week) Monday- Saturday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (8:00am - 8:00pm Monday-Friday and 9:00am - 1:00pm Saturday). It may be necessary, given the business need, to work occasional overtime.
The role of the Services
Advocate is to build trusted relationships with members across their health
care lifecycle. This is done by assisting members with their customer
service needs, educating members about management of their health and well-being,
helping members to maximize health plan benefits and personal health care
dollars and owning customer service inquiries through to
resolution. Another purpose of this position is to support the
mission, vision and values of the organization and department through quality,
service, innovation, integrity, teamwork and dignity/respect. The
employee specifically contributes to organizational/departmental success
- Member satisfaction with OptumHealth Collaborative Care, guest/member retention, and guest/member contacts/information gathering
- Policy/process identificationand improvement
- Ongoing quality improvementfor customer care interactions
- Providing Excellent CustomerCare to our guests/members
- Accountable for problem resolution of customer issues andto communicate resolution to appropriate parties.
- Available, as scheduled, to respond to calls fromcustomers regarding claims payments, benefits, eligibility, and certificationissues.
- Investigate issues and document steps taken to achieveresolution.
- Coordinates the provision of multiple services topatients performing a full range of administrative support services forclinic/site including registration and scheduling of patients for medicalprocedures, tests, associated ancillary services and other relatedduties. Responsible for providing the highest level of patient/customersatisfaction. Respond to customers regarding status of formalcomplaints or appeals.
- Verifies, re-verifies and authorizes patient insurancecoverage and eligibility utilizing computer based patientregistration/scheduling system. Verifies and updates demographic,insurance, and other patient information. Confirms, collects, and postspatient co-payments and other outstanding balances.
- Participates on a variety of committees that relate toappointment schedules as the expert in the creation and maintenance of providerschedules.
- Provides patient education regarding managed care plansand referral process. Assists patients with referral questions, concerns,etc. Counsels and advises patients of available options.
- Enters new referrals or ensures that existing referralnumbers are linked in the system to ensure managed care requirements aremet.
- Reconciles all referral discrepancies. Callspatients, employers, insurance companies, etc., as required for furtherverification of insurance, demographic data, medical service authorization,etc.
- Works collaboratively with primary care practices,patients and specialty practices to process outgoing referrals prior toscheduled visits. Follows up with practices that do not issue a referralor obtain referral on a timely basis.
- Interfaces with staff, providers and patients regardingdenied referrals. Documents information and assists with alternate plan ofcare, if needed.
- Follows up on a variety of reports, such as indisposedreferral report, etc., resolving discrepancies as required.
- Escalate issues to Senior Customer Service Reps whenappropriate.
- Meet departmental standards for production and quality.
- Meet departmental standards for schedule adherence.
- Participate in training and self-developmentopportunities when appropriate.
- Demonstrate a cooperative, positive attitude in theworkplace.
- Demonstrate a basic knowledge of managed healthcare andclaims.
- Perform all otherduties as deemed appropriate to provide customer service
- Adhere to qualityimprovement initiatives.
- Special projects asrequired
- Connect members with internal specialists for assistancewhen needed
- Partner with others to resolve escalated issues
- Provide education and status on previously submittedpre-authorizations or pre-determination requests.
- Mentor new hiresand existing staff in the efficient use of call handling best practicesdesigned to ensure accurate and consistent call responses
- Launch outboundcalls as appropriate
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.
- High school diploma/GED (or higher)
- 1+ years of Customer service experience
- Ability to type 30+ WPM
- Familiaritywith computer and Windows PC applications, which includes the ability tonavigate and learn new and complex computer system applications
- Available to work 40 hours per week anytime within theoperating hours of the site, which may include weekends and holidays
- Healthcare experience
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
Keywords: customer service representative, customer service, CSR, UnitedHealth Group, call center, UnitedHealthcare, Optum, health care, office, phone support, training class, SME, Senior, SR