Customer Service Representative

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

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. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of between 7:00am – 9:00pm CST, Saturday 8:00am – 5:00pm CST. Open most holidays from 8:00am-5:00pm CST. It may be necessary, given the business need, to work occasional overtime.

Shift bids (schedule reassignments) occur 1-2 times per year, depending on business needs. During the shift bid process, your schedule will change. You will have the option to rank your preferred schedules, and the awarded schedule will be determined based on individual performance and metric ranking.

We offer 3 weeks of paid training. The hours during training will be 8:00am to 4:30pm CST, Monday – Friday. Training will be conducted virtually from your home.

                     

Primary Responsibilities:

• Answer 50-70 incoming phone calls per day from members and identify the type of assistance needed. Will be taking calls to verify benefit coverage, prior authorization approval, checking on status of prior authorization and educating members on appeal option.    
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues. 
• As a member of our Prior Authorization (Prior Auth) team, the Customer Service Representatives (CSRs) are entrusted with the responsibility of interfacing directly with members to support and guide them through the intricacies of the prior authorization process. The training class for the Customer Service Reps will encompass the following key duties:
• Educate Members on Status Updates: CSRs will be thoroughly trained to provide accurate and timely updates to members regarding the status of their prior authorization requests. They must ensure that members are kept informed throughout every step of the process.
• Clarify Decision Outcomes: It is crucial for CSRs to communicate the decisions regarding prior auth requests clearly and compassionately. They must be prepared to explain the rationale behind the decisions and what those decisions entail for the members.
• Insight on Appeals Information: In instances where a prior auth request is denied, CSRs will provide members with comprehensive information on the appeals process. This includes guiding them on how to initiate an appeal, the documentation required, and the timeline for the appeals process.
• Provide Alternatives and Cost-Saving Options: When appropriate, CSRs will suggest alternative therapies or medications that may be more cost-effective or better suited to the member’s needs, always in consultation with medical guidelines and coverage policies.
• You’ll be handling difficult types of calls and cases dealing with personal and confidential health care issues as it relates to Prior Authorization
• In this position, you may receive calls from frustrated members. It is important to remember that they are upset about the situation they are in and not necessarily with you directly. You will need to be able to move on to the next call without letting the previous call upset you. To do so you will need:
  • Patience and the ability to deal with frustration and maintain positive attitude even in the face of an upset caller

 

This role is equally challenging and rewarding. You’ll be called on to research complex issues across multiple databases. It requires fluency in computer navigation and toggling while you confidently and compassionately engage in dialogue with the caller. Be assured that our training will provide you with knowledge of the various products, plans and levels of benefits available to members and you’ll soon find yourself creating positive experiences and earning the gratitude of callers on an hourly basis.

              

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 equivalent work experience
• Must be 18 years of age OR older 
• Ability to handle 50-70 calls daily 
• Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Windows and mouse/keyboarding skills; ability to navigate through systems and screens (as many as 8 different screens)
• Ability to attend 100% of training Monday – Friday 8:00am – 4:30pm CST
• Ability to work any of our 8-hour shift schedules during our normal business hours of between 7:00am – 9:00pm CST, Saturday 8:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime
• Ability to have your schedule change per business need

            

Preferred Qualifications:

• 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• Health care experience

               

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:

• Patience and the ability to deal with frustration and maintain positive attitude even in the face of an upset caller
• Ability to deliver difficult information constructively and empathetically
• Compassion and understanding for customers
• Customer Service attitude – we emphasize Customer Care, ownership and resolution follow through as you represent OptumRx in the eyes of every caller
• Strong communication skills with a professional attitude and demeanor
• Ability to multi-task – listen and type at the same time Heavy production case review driven
• Heavy emphasis on quality and productivity of work
• Demonstrated ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
• Proficient conflict management skills to resolve issues in a stressful situation

                 

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

                       

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 – $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

 

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

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