Job Description

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.
In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.
Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.
A typical day as a Customer Service Representative in a call center environment involves managing a variety of inbound calls from both members and medical providers, including escalations from offshore provider teams. You'll assist providers from UHN and non-UHN networks with custom benefit questions related to employer-specific plans administered by UMR as a third-party administrator (TPA). This includes explaining complex insurance details to hospitals, clinics, and members, ensuring clarity and accuracy. Throughout the day, you may navigate approximately eight different systems to research benefit information, interpret plan documents, and provide clear, concise answers. While most interactions are with members and providers, occasional calls from brokers may occur, requiring collaboration with internal account teams. The role demands strong problem-solving skills, attention to detail, and the ability to communicate effectively to deliver exceptional service across all customer groups.
This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer 6 weeks of paid training. The hours during training will be 8:00am - 4:30pm CST from Monday - Friday. Training will be conducted virtually from your home.
Primary Responsibilities:

• Respond to and resolve, on the first call, customer service inquiries and issues from a number of sources (Provider, Member, Customer)
• Research complex issues using multiple UMR proprietary applications and databases and work with appropriate internal support resources to resolve customer issues and/or partner with Supervisor to resolve escalated issues
• Help members locate providers, understand their benefit plan and answer questions related to processed claims
• Collaborate effectively with multiple internal partners to ensure issues are resolved and thoroughly communicated to providers, members, and customers in a timely manner.
• Research and dissect complex prior authorization and claim issues and take appropriate steps to resolve identified issues to avoid repeat calls, escalations, and provider dissatisfaction.
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures to adjudicate complex claims (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
• Strong multitasking to effectively and efficiently navigate more than XX systems to extract necessary information to resolve and
• Meet the performance goals established for the position in the areas of: quality, productivity, member satisfaction and attendance

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 Diploma / GED
• Must be 18 years of age OR older
• 1+ years of customer service experience analyzing and solving customer's concerns
• Ability to work full-time between 7:00am - 7:00pm CST including the flexibility to work occasional overtime given the business need

Preferred Qualifications:

• 2+ years of customer service OR experience in the healthcare industry

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Verbal/Written Communication
• Active Listening
• Negotiation
• Empathy/Sensitivity
• Patience/Resilience
• Agility/Flexibility
• Conflict Resolution
• Cultural Sensitivity
• Effective time and resource management
• Disability & Diversity Awareness

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 - $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Skills Required