Claims Customer Service Representative

Optum is a global organization that delivers care aided by technology to help millions of people live healthier lives. The Claims Customer Service Representative will be responsible for delivering exceptional customer service by answering calls, resolving issues related to health care eligibility, claims, and payments, while maintaining strong relationships with members and providers.

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
• Reside within the state of Minnesota, Iowa, North Dakota, South Dakota, OR Wisconsin
• 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
• Ability to multi - task duties as well as the ability to understand multiple products and multiple levels of benefits within each product
• Demonstrated ability to listen skillfully, collect relevant information, build rapport, and respond to customers in a compassionate manner
• Strong communication skills, empathy
• Critical thinking skills to problem solve and resolve customer concerns
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
• Health care experience
• Call center experience