Customer Service Representative - Remote in CST

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.

This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm 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 to 5:00pm CT, Monday - Friday. Training will be conducted virtually from your home.

If you are located within Central Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• This role involves primarily handling incoming calls in a call center queue, must be capable of managing these calls for most of your workday
• Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)
• Ensure that proper benefits are applied to every claim
• Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow - up with the member or provider
• Apply knowledge of customer service requirements to process claims appropriately (e.g., Service Level Agreements, performance guarantees)
• Identify and apply knowledge of new plans/customers to process their claims appropriately
• Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)
• Research complex issues across multiple databases and work with support resources to resolve customer issues and / or partner with others to resolve escalated issues
• Provide education and status on previously submitted pre - authorizations or pre - determination requests
• Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 work experience
• Must be 18 years of age OR older
• 2+ years of experience in customer service role
• Experience in Microsoft Excel - data entry, sorting, creating / modifying spreadsheets
• Experience in Microsoft One Note - data entry and documentation creation
• Ability to work the hours of 8:00am - 5:00pm CST

Preferred Qualifications:

• 1+ years of Call Center experience
• Claims customer service experience
• Experience with medical terminology
• Behavioral Health experience

Telecommuting Requirements:

• Reside within Central Time Zone
• 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.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

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