Job Abstract

If you are located within commutable distance of 2 West Fern Ave, Redlands, CA, 92373, you will have the flexibility to telecommute* (work from home) 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, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. 2 West Fern Ave, Redlands, CA, 92373 and will need to visit the office.

We offer 2 weeks of on-the-job training. The hours of training will be aligned with your schedule.

*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

Primary Responsibilities:

• Accountable for problem resolution of customer issues and to communicate resolution to appropriate parties:
  • Available, as scheduled, to respond to calls from customers regarding claims payments, benefits, eligibility, and certification issues
  • Investigate issues and document steps taken to achieve resolution
  • Manage resolution of issues through contact with the claims department, case management, and external payers ultimately achieving a positive outcome
  • Investigate and handle retro - certification activities, as required for resolution of customer issues
  • Respond to customers regarding status of formal complaints or appeals
• Handle and resolve escalated issues when appropriate
• Meet departmental standards for production and quality
• Meet departmental standards for schedule adherence
• Participate in training and self - development opportunities when appropriate
• Demonstrate a cooperative, positive attitude in the workplace
• Demonstrate a basic knowledge of managed healthcare and claims
• Perform all other duties as deemed appropriate to provide customer service
• Answer and respond to member inquiries regarding effective and efficient handling of incoming call / claim issues
• Ability to review and handle appropriately:
  • Network and member contract questions
  • Claims Issues
  • Pharmacy / vision / dental / chiropractic issues
  • Coordination of Benefits (Medicare Estimation and when is applies)
• Adhere to quality improvement initiatives
• Special projects as required
• Resolve member service inquiries related to:
  • Medical benefits, eligibility and claims
  • Financial spending accounts
  • Pharmacy benefits, eligibility and claims
  • Correspondence requests
• Educate members about the fundamentals of consumer - driven health care including:
  • Managing health and well being
  • Maximizing the value of their health plan benefits
  • Choosing a quality care member
  • Premium member education and steerage
• Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member
• Help members navigate myuhc.com, lifeprinthealth.com, and other UnitedHealth Group websites
• Research complex issues across multiple databases and work with support resources to resolve member issues
• Assist members with member appointment scheduling
• Connect members with internal specialists for assistance when needed
• Partner with others to resolve escalated issues
• Provide education and status on previously submitted pre - authorizations or pre-determination requests.
• Assist Supervisor team with escalated issues
• Mentor new hires and existing staff in the efficient use of call handling best practices designed to ensure accurate and consistent call responses
• Launch outbound calls as appropriate
• Provides targeted coaching to frontline Service Advocates (side - by - side)
• Coaches staff on call handling techniques to effectively Connect, Help, and Solve
• Serve as an expert by answering questions and accepting escalated calls from the team
• Assist in researching and responding to complex customer calls within current turnaround standards
• Provides feedback to the team with guidance from the Supervisor
• Supports new team members to help make a successful transition to the floor
• Tracks and trends issues from the floor (technical clarification, systems)
• Makes recommendations on process improvements
• Accepts inbound calls to ensure continued superior performance with metrics
• Identifies potential gaps in knowledge based on performance results
• Filters feedback and documentation for curriculum revisions to training
• Works with the Supervisor and team to tackle performance opportunities
• Tracks training needs or other areas noted for improvement, and sends documentation to appropriate area
• Executes special projects as required (i.e., audits, project pilots, etc.)
• Assisting supervisor with daily / weekly / monthly call center reports

Youll 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
• Must be 18 years of age OR older
• 2+ years of call center and / OR customer service experience
• Ability to type at the speed of 30+ WPM (words per minute)
• Proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications
• Successful completion of United Health Care Operations CCP new hire training and demonstrated proficiency
• Ability to travel up to 10% of the time
• Ability to work any shift between the hours of 8:00 AM - 5:00 PM from Monday - Friday

Preferred Qualifications:

• Bilingual fluency in English and Spanish
• Knowledge of HMO / PPO / Medicare Plans / benefits and medical terminology
• Healthcare experience

Telecommuting Requirements:

• Reside within a commutable distance of 2 West Fern Ave, Redlands, CA, 92373
• 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

California Residents Only: The hourly range for this is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited tolocal 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, youll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location, and incomedeserves 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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