Customer First Representative

UnitedHealth Group • Wausau, WI

308d • $16 - $33 • Remote

About The Position

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 (subject to trainer availability). 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 and attendance during training is 100% mandatory. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

Requirements

• High School Diploma / GED OR 10+ years of equivalent work experience
• Must be 18 years of age OR older
• 1+ years of customer service experience in an office OR professional setting
• This position will receive provider calls up to 50-70 calls daily and requires full attention to work duties. Employees in this role must be able to ensure they will have uninterrupted work time while they are on shift (outside of normally scheduled breaks and lunch)
• Ability to successfully complete the Customer Service training classes and demonstrate proficiency of the material
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 8:00pm CST, Monday - Friday

Nice To Haves

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

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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED