You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
Positions in this function are responsible for providing expertise in QA and customer service support to members, customers, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries.
- Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, hospitals, vendors)
- Make outbound calls to perform vendor QA process
- Demonstrate understanding of internal/external processes that may drive caller questions/issues (e.g., provider related issues)
- Ask appropriate questions and listen actively to identify underlying questions/issues (e.g., root cause analysis)
- Gather appropriate data/information and perform initial investigation to determine scope and depth of question/issue
- Proactively contact external resources as needed to address caller questions/issues (e.g., providers, Medical Groups)
- Utilize appropriate knowledge resources to drive resolution of applicable questions/issues (e.g., websites, CRM tools, knowledge bases, product manuals, SharePoint)
- Identify and communicate steps/solutions to caller questions/issues, using appropriate problem-solving skills and established guidelines, where available (e.g., workarounds, descriptions of relevant processes, conflict resolution)
- Offer additional options to provide solutions/positive outcomes for callers (e.g., negotiate payment)
- Drive resolution of caller questions/issues on the first call whenever possible (e.g., first-call resolution, one-and-done)
- Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution)
- Develop and Maintain Productive Relationships/Interactions with Callers
- Manage caller conversations appropriately (e.g., provide a good first impression, command attention and respect, maintain professional tone, demonstrate confidence, de-escalate/defuse callers as needed)
- Maintain ongoing communications with callers during the resolution process to communicate status updates and other required information
- Acknowledge and demonstrate empathy/sympathy with providers (e.g. Requesting extensions)
- Demonstrate knowledge of applicable health care terminology (e.g., medical, behavioral)
- Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements/2 member names)
- Demonstrate knowledge of established workflows and support processes (e.g., available resources, internal/external business partners, points of contact)
- Demonstrate knowledge of relevant internal processes impacting caller issues (e.g., payment processing, retrieval methods, provider contracts)
- Identify inaccurate/inconsistent information found in systems/tools, and communicate to appropriate resources (e.g., ChartFinder, policies/procedures)
- High School Diploma / GED (or higher)
- 2+ years of experience in an inbound / outbound call center
- 1+ years of experience in Microsoft Office with the ability create, edit, copy, send and save documents, correspondence, and spreadsheets in Word, Excel, and Outlook
- Ability to work between 7:00 am - 6:00 pm Monday through Friday
- QA experience
- Knowledge of Coding
- Intermediate Knowledge of in Excel (Filtering, Pivot tables)
- Good communication skills (Written and Verbal)
- Excellent phone etiquette
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: Optum, healthcare, Research, Analyst, QA