Customer First Representative - National Remote

UnitedHealth Group • Full-time • Remote (San Antonio, TX, US) • $16 - $33 / hour • 1d ago

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 7:00 AM - 8:00 PM 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 8:00 AM - 4:30 PM CST from 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. Attendance during training is 100% mandatory. Training will be conducted virtually from your home.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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’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 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
Ability to successfully complete the Customer Service training classes and demonstrate proficiency of the material
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 work any of our 8-hour shift schedules during our normal business hours of 7:00 AM - 8:00 PM CST from Monday - Friday including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

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

Telecommuting Requirements:

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 in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a 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
Flexibility to customize approach to meet all types of member communication styles and personalities
Proficient problem - solving approach to quickly assess current state and formulate recommendations
Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrate personal resilience
Ability to multi - task as well as the ability to understand multiple products and multiple levels of benefits within each product
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 as needed

All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

The hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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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