Job Description

You\xe2\x80\x99ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. At UnitedHealthcare , we\xe2\x80\x99re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life\xe2\x80\x99s best work. SM You like working with people. Even more so, you like helping them. This is your chance to join a team dedicated to helping our members and their families every day. In this joint role as a Customer Service and Claims Representative, you\'ll join us on a mission to not only deliver the best customer service in the health care industry, but the best customer service. Period. Your compassion and customer service expertise combined with our support, training and development will ensure your success. This is no small opportunity. This is where you can bring your compassion for others while doing your life\'s best work. SM In this role, you play a critical role in creating a quality experience for the callers that you connect with and those that you correspond with. Every interaction gives you that opportunity to improve the lives of our customers and exceed their expectations. You\'ll spend the majority of your day by responding to calls from our members and help answer questions and resolve issues regarding health care eligibility, claims and payments. You\'ll also spend a portion of your time reviewing, researching and processing healthcare claims with the goal to ensure that every claim has a fair and thorough review. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:30am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime. We offer 5 weeks of training. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. *All Telecommuters will be required to adhere to UnitedHealth Group\xe2\x80\x99s Telecommuter Policy. Primary Responsibilities:

• Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
• Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
• Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
• Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance

You\xe2\x80\x99ll be rewarded and recognized for your perfor mance 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 (or higher) OR equivalent work experience
• Minimum of 2+ years of combined education, work and/or volunteer experience
• Ability to successfully complete the Customer Service training classes and demonstrate proficiency of the material
• Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed

Preferred Qualifications:

• Health Care/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design)
• Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)
• Sales or account management experience
• Customer Service experience

Telecommuting Requirements:

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

Careers with UnitedHealthcare. Work with a Fortune 5 organization that\xe2\x80\x99s serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none. California, Colorado, Connecticut, Nevada, Washington or New York, Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $16.00 - $31.44.Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you\xe2\x80\x99ll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone\xe2\x80\x93of every race, gender, sexuality, age, location and income\xe2\x80\x93deserves 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 \xe2\x80\x94 an enterprise priority reflected in our mission.
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. #RPO #YELLOW