Provider Service Representative

UnitedHealth Group • Ontario, CA

8d • $20 - $36 • Onsite

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Requirements

• High School Diploma / GED
• 3+ years of managed care or medical insurance experience with provider network management (to include provider claims, credentialing, contract documentation and configuration processing required. Knowledgeable of HMO, Commercial, Medicare, Medicaid lines of business)
• 1+ years of experience with communication skills including telephone etiquette
• 1+ year of experience managing provider network
• Intermediate level of proficiency with Microsoft Office programs including Excel and Word

Nice To Haves

• Bilingual (English/Spanish)

Responsibilities

• Assist in end-to-end provider claims and help enhance call quality
• Assist in the design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
• Support development and management of provider networks
• Help implement training and development of external providers through education programs
• Supports and remains accessible to providers and their office staff. Leaves specific instructions about how to be reached within and outside the office. Utilizes email and the cell phone to maintain productivity within and outside the office. Schedules regular visits with physician offices to provide education, training and customer service. Establishes and maintains strong, productive relationships with office staff by providing superior customer service and effectively solving issues. Stays current with activities in the market by developing an open rapport with the offices. Represents the IPA in all meetings with network providers in an appropriate and professional manner. Collaborates with leadership to prioritize high- impact providers and proactively address network challenges
• Coordinates and conducts meetings within assigned within the provider networks. Sends announcements regarding scheduled meetings, makes phone calls to verify attendance (quorum), orders refreshments and sets up/breaks down the meetings. Prepares, or directs the preparation of, agendas, handouts and meeting minutes. Represents management at all meetings with clients in an appropriate and professional manner
• Serves as a resource for network provider issues. Supports the Client Services Department in resolving provider issues and responds to training needs identified by other MSO departments such as Claims and Medical Management. Interfaces with Health Plan staff as required. Effectively problem solves issues as identified; documents all contact with providers/office staff in the provider’s file. Monitors client needs to evaluate satisfaction levels, and identifies trends and areas requiring improvement. Identifies recurring issues and collaborates with teams to refine training content and improve cross-departmental processes
• Identify gaps in network composition and services to assist network contracting and development teams
• All other duties as assigned

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED