Claims Customer Service Representative

Optum is a global organization that delivers care aided by technology to help millions of people live healthier lives. In this role, you will provide exceptional customer service by assisting callers with health care eligibility, claims, and payments, while aiming to resolve their issues efficiently and effectively.

Responsibilities:

• Answer incoming phone calls from customers (i.e., members, providers, facilities) in a call center setting and identify the type of assistance needed (i.e., benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits, and claims information)
• Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
• Deliver information and answer questions in a positive manner to facilitate strong relationships with members and providers
• 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
• Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, and attendance

Requirements:

• High School Diploma / GED
• Must be 18 years of age OR older
• 1+ years of experience in a related environment (i.e., call center, customer service, office etc.) using phones and computers as the primary job tools
• Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Ability to successfully complete the Customer Service training classes and demonstrate proficiency of the material
• Ability to work full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime
• Health care experience
• Call center experience