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Cust Service Rep Sr

UnitedHealth Group

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Job Details

729684 Cust Service Rep Sr

Cust Service Rep Sr (729684)

Position Description

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant ? and built for speed.

The Senior Customer Service Representative is responsible for handling all incoming Billing and Eligibility phone calls and for serving as the primary customer interface for departmental inquiries.

? Ensures quality customer service for internal and external customers:
? Responds to incoming customer service requests, both verbal and written.
? Identifies and assesses customers' needs quickly and accurately.
? Solves problems systematically, using sound business judgment.
? Partners with other billing and eligibility department representatives to resolve complex customer service inquiries.
? Monitors delegated customer service issues to ensure timely and accurate resolution.
? Applies appropriate communication techniques when responding to customers, particularly in stressful situations.
? Informs and educates new customers regarding billing/invoicing set up and billing/payment procedures.
? Places outgoing phone calls to complete follow-up on customer service requests as necessary.
? Responds to customer service inquiries in writing as necessary.
? Processes member terminations (i.e. phone disenrollment).
? Establishes and demonstrates competency in eligibility, billing and receivable systems and associated applications. Implements customer service strategies and recommends related improvements/enhancements.
? Maintains timely, accurate documentation for all appropriate transactions.
? Makes corrections and adjustments.
? Consistently meets established productivity, schedule adherence, and quality standards.
? Proactively seeks to further develop billing and accounts receivable competencies.
? Keeps management abreast of all outstanding issues.
? Adapts procedures, processes, and techniques to meet the more complex position requirements.
? Participates in load balancing.
? Addresses special (ad-hoc) projects as appropriate.
? Seeks involvement in continuous quality improvement initiatives.
? Ensures quality customer service for internal and external customers.

Job Title: Customer Service Specialist (Claims)
Job Code: 0055
Organization: 1 WellMed 0 PHC 0 Comfort Care
Department: Claims
Reports To: CS Claims Supervisor
FLSA Status: Non-Exempt

Job Summary
The Customer Service Specialist provides expert service to providers and patients who have claims related questions by promptly responding to their concerns in a timely manner. In addition, this position will resolve payment/adjudication questions at the time the call is received; explaining calculation methodology, contract terms, procedures, etc.

Essential Job Functions
1. Clearly communicates claims status, payment methodology, contract terms, procedures, etc. to customer.
2. Identifies trends in errors or inquiries and reports these to appropriate personnel.
3. Informs and assists callers with the claims appeals process, if necessary.
4. Develops a tracking system to ensure that all priority issues are handled within established time frames and proactively notifies customers of anticipated delay.
5. Answer customer service lines promptly and professionally and maintain at least a 95% response time.
6. Demonstrate excellent customer service by determining the reason for the call, acknowledging the callers concerns and resolve concerns and/or explain action to be taken within the expected time line for resolution.
7. Performs research on complex claim inquiries and expertly re-examines claims.
8. Serves as a resource to medical group staff, network providers, health plan representatives and claims staff.
9. Presents a pleasant voice to all callers, regardless of the stressful nature of the situation.
10. Performs all other related duties as assigned.

Minimum Required Education, Experience & Skills
High School Diploma or GED required.
Two years? experience in a health care or managed care customer service environment.
Must have excellent verbal communication skills and customer service skills.
Working knowledge of Microsoft Office applications including Excel, Access and Word.

Preferred Education, Experience & Skills
Associate?s Degree in Business or Information Systems preferred.
One to two years? experience working in a Healthcare claims environment preferred.
Knowledge of HCFA guidelines and Medicare claims payment rules and claims policies and procedures.
? 1 year of customer service experience analyzing and solving customer problems, OR 1 year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
? An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
? Authorization to work in the United States
? Available to work 40 hours per week anytime within the operating hours of the site
? Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
? Ability to navigate a computer while on the phone
? Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
? Ability to remain focused and productive each day though tasks may be repetitive
? Willing to work and contribute in a team environment.
? Ability to execute own assignments under direction of experienced staff.
? Ability to balance and prioritize multiple tasks.
? Flexible to change.
? Responsive to management's requests and suggestion; takes direction.
? Develops goals for self and monitors progress.
? Seeks assistance as appropriate.
? Ability to trouble-shoot problems.
? Completes assignments thoroughly, accurately and on time.
? Demonstrates the potential for development of strong written and verbal communication skills.
? Persists at tasks and maintains high energy level.
? Listens effectively.
? Seeks additional job responsibilities.
? Demonstrated ability in customer service problem resolution and relationship building.
? Demonstrates advanced knowledge of Billing/Finance and Eligibility processes, practices and concepts.
? Has firm understanding of the problems and issues of clients and the business environment.
? Demonstrates customer education and negotiation skills.
? Basic knowledge of managed care industry preferred.
? Demonstrates basic analytical skills.
? Orientation towards team environment.

Requirements and Work Environment:
? Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
? Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity Take the next step, online at:

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Details

  • Contest Number729684
  • Job TitleCust Service Rep Sr
  • Job FamilyCustomer Services
  • Business SegmentOptumCare

Job Location Information

  • TX
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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