Responsible for representing the organization and functioning as a key communicator for the organizations members and providers. Educates and informs customers of organizations programs and services. Promotes company’s commitment to superior customer service. Proactively and reactively seeks appropriate solutions to potential and existing service issues. Identifies root cause issues and works diligently and cooperatively to minimize or eliminate issues.
Receives and records customer concerns via phone. Acts to resolve concerns in accordance for corporate guidelines and standards for all areas of claims, authorizations and IPA functionality
Functions as liaison between member, physician, health plan, and IPA staff
Ability to interpret provider and health plan contracts to ensure accurate responses to calls
Log issues into the Customer Service Tracking database that require resolution and/or follow-up.
Plan and organize workload to ensure efficient and timely resolution of issues
Respond to callers with the resolution of issues in a timely manner in accordance with the guidelines set by the department
Participates in senior outreach program via telephone with approved script
Participates in telephonic surveys as required by management
Follow and support the guidelines set by the department and organization to ensure overall goals are met
Maintain minimum standards for the department for quality and quantity of calls received
Foster interpersonal relationships, showing empathy and understanding towards staff, protecting individual self-esteem. Understand own impact on others; interact effectively with peers, subordinates, and supervisors
Any other assigned
1 year of working in a Medicare and HMO environment
1 year of Customer Service experience
Proficient in office system (Windows PC)
High school diploma or GED OR 10 years of equivalent working experience
Claims processing experience highly preferred
Authorization / referral processing experience
Ability to identify confidentiality and its requirements (HIPAA)
Knowledge of standard billing practices
Ability to interpret provider and health plan contracts
Excellent communication skills, including good grammar, voice and diction
Strong organizational and prioritization skills
Able to represent the company in a professional and positive manner
Ability to retain composure in stressful situations
Ability to de-escalate potential volatile situations
Strives to be a team player
Must have excellent, writing, punctuation, grammatical and spelling skills
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
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.
Job Keywords: Customer service, Medicare, HMO, Healthcare, HIPAA, prior authorization, Word, Excel, Outlook, Palm Desert, CA, California