If you are located within the state of West Virginia, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

At UnitedHealthcare , we’re 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’s best work.SM

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.

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.

The Customer First Representative is a hybrid role in which you will handle Calls and Claims while delivering the best customer service in the healthcare industry to our members.

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 7 : 00am - 8 : 00pm CST.

It may be necessary, given the business need, to work occasional overtime.

We offer an initial 6 weeks of paid training related to taking calls. The hours during training will be 8 : 00am to 4 : 30pm CST, Monday - Friday.

Within 6-8 months after the initial call training, you will attend an additional 5 weeks of claims training. Training will be conducted virtually from your home.

All Telecommuters will be required to adhere to UnitedHealth Group’s 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)
• Meet the performance goals established for the position in the areas of : efficiency, accuracy, quality, 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 OR equivalent working experience
• 1 years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications
• Ability to successfully complete the Customer Service training classes and demonstrate proficiency of the material
• Must be 18 years of age OR older
• Ability to work regularly scheduled shifts within our hours of operation (7 : 00am- 8 : 00pm CST Monday - Friday) 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 :

• 1 years experience in customer service call center within the healthcare insurance industry
• Experience working with medical claims processing
• Familiarity with medical terminology, health plan documents, or benefit plan design
• Prior experience utilizing multiple systems / platforms while on a call with a member

Telecommuting Requirements :

• Reside within the state of West Virginia
• 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 :

• Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner, consistently meeting commitments)
• Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
• Proficient problem-solving approach to quickly assess current state and formulate recommendations
• Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
• Flexibility to customize approach to meet all types of member communication styles and personalities
• Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilience

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.

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

Last updated : 2024-05-06