Energize your career with one of Healthcare’s
fastest growing companies.
Like you, UnitedHealth Group is strong on innovation. And like you, we'll go the distance to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have a chance to make an impact.
- Respond to Incoming Provider and Enrollee calls
- Resolve Customer Service inquiries
- Provide excellent Customer Service to both Providers and Enrollees.
- Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
- Receives Care Coordination notification cases for non-clinical assessment / intervention and provides appropriate triage
- Processes out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products
- Processes notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues
- Determines benefit coverage issues based on employer group contracts
- Sets up/documents / triages cases for (CCR) Clinical Coverage Review
- Ensures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable
- Processes letters within DOL time frames
- Verifies appropriate ICD-10 and CPT coding usage
- Communicates to providers and members benefit determinations within DOL time frames
- Assist with faxes and emails
- Moderate work experience within own function
- Some work is completed without established procedures
- Basic tasks are completed without review by others
- Supervision / guidance is required for higher-level tasks
- Other duties as assigned by manager and / or director
- High School Diploma / GED (or higher)
- 1+ years of professional experience in an office / customer service environment
- Previous experience working with Microsoft Word, Microsoft Excel, and Microsoft Outlook (ability to create, edit and save)
- Computer experience including, but not limited to, ability to learn new computer system applications
- Flexibility to work outside standard hours of operations due to changing business needs
- Must have a quiet designated work space and access to install secure high speed internet (minimum speed 1.5 download mps and 1 upload mps) via cable/DSL in home (NOTE: wireless/cell phone provider, satellite, microwave, etc...does NOT meet this requirement)
- Bachelor's Degree (or higher)
- Familiar with Aerial (documentation program)
- OnBase experience
- Familiar with Jacada
- Sutter experience
- Professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties, or Customer Service experience analyzing and solving customer's problems
- Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-10 and CPT codes, Medicare and / or Medicaid Services, Call Center environment
- Professional experience in a Clerical or Administrative support related role
- Bilingual fluency in English and Spanish
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM
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.