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.
This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours.
Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission / discharge information post - notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers / members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles.
- Manage administrative intake of members
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and / or providers
- Process incoming and outgoing referrals, and prior authorizations, including intake, notification and census roles
- Assist the clinical staff with setting up documents / triage cases for Clinical Coverage Review
- Handle resolution / inquiries from members and / or providers
- 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.
- HS Diploma / GED or higher
- 2+ years of customer service experience
- Proficiency in Microsoft office suite including Word (creating, saving, formatting documents), Excel (ability to create, copy, edit, send, navigate using tabs, and save spreadsheets) and Outlook (ability to open and send emails)
- Experience working within the health care Industry and with health care insurance
- Bachelor's Degree (or higher) in Counseling, Social Work, Sociology or equivalent degrees.
- Experience working in a hospital, physician's office or medical clinic setting
- A clerical or administrative support background
- Knowledge of medical terminology
- Knowledge of ICD - 9 and CPT codes
- Experience working in a call center
- Bilingual in English and Spanish.
Join us today and we can provide you with meaningful challenge that can result in a strong sense of impact and fulfillment. It's truly an opportunity to do your life's best work.SM
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to 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.
Keywords: Clinical, Administrative, Administrator, UnitedHealth Group, Richmond, VA