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Customer Service Representative (Healthcare) - Palm Desert, CA

UnitedHealth Group

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Job Details

743043 Customer Service Representative Healthcare Palm Desert CA

Customer Service Representative (Healthcare) - Palm Desert, CA (743043)

Position Description

Responsible for representing the organization and functioning as a key communicator for the organizations members and providers.  Educates and informs customers of organizations programs and services.  Promotes company’s commitment to superior customer service.  Proactively and reactively seeks appropriate solutions to potential and existing service issues.  Identifies root cause issues and works diligently and cooperatively to minimize or eliminate issues.

Primary Responsibilities:

  • Receives and records customer concerns via phone. Acts to resolve concerns in accordance for corporate guidelines and standards for all areas of claims, authorizations and IPA functionality

  • Functions as liaison between member, physician, health plan, and IPA staff

  • Ability to interpret provider and health plan contracts to ensure accurate responses to calls

  • Log issues into the Customer Service Tracking database that require resolution and/or follow-up.

  • Plan and organize workload to ensure efficient and timely resolution of issues

  • Respond to callers with the resolution of issues in a timely manner in accordance with the guidelines set by the department

  • Participates in senior outreach program via telephone with approved script

  • Participates in telephonic surveys as required by management

  • Follow and support the guidelines set by the department and organization to ensure overall goals are met

  • Maintain minimum standards for the department for quality and quantity of calls received

  • Foster interpersonal relationships, showing empathy and understanding towards staff, protecting individual self-esteem.  Understand own impact on others; interact effectively with peers, subordinates, and supervisors

  • Any other assigned

Required Qualifications:

  • 1 year of working in a Medicare and HMO environment

  • 1 year of Customer Service experience

  • Proficient in office system (Windows PC)


Preferred Qualifications:

  • High school diploma or GED OR 10 years of equivalent working experience

  • Claims processing experience highly preferred

  • Authorization / referral processing experience

  • Ability to identify confidentiality and its requirements (HIPAA)

  • Knowledge of standard billing practices

  • Ability to interpret provider and health plan contracts

  • Excellent communication skills, including good grammar, voice and diction

  • Strong organizational and prioritization skills

  • Able to represent the company in a professional and positive manner

  • Ability to retain composure in stressful situations 

  • Ability to de-escalate potential volatile situations

  • Strives to be a team player

  • Must have excellent, writing, punctuation, grammatical and spelling skills



Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)



North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.


The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.



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 Keywords: Customer service, Medicare, HMO, Healthcare, HIPAA, prior authorization, Word, Excel, Outlook, Palm Desert, CA, California

Job Details

  • Contest Number743043
  • Job TitleCustomer Service Representative (Healthcare) - Palm Desert, CA
  • Job FamilyCustomer Services
  • Business SegmentOptumCare

Job Location Information

    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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