Lead Customer Service Representative

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. As a Lead Customer Service Representative, you will deliver exceptional experiences to callers, resolve complex customer issues, and support team members as a subject matter expert. This role involves handling customer inquiries and ensuring high-quality service delivery while meeting performance goals.

Responsibilities:

• Serve as a resource or Subject Matter Expert (SME) for other team members or internal customers
• Handle escalated calls, resolving more complex customer issues in a one and done manner
• Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
• Intervene with care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed
• Assist customers in navigating UnitedHealth Group websites and encourage and reassure them to become self-sufficient
• Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
• Provide education and status on previously submitted pre-authorizations or pre-determination requests
• Meet the performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance

Requirements:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• All new hires will be required to successfully complete the Customer Service training classes and demonstrate proficiency of the material
• Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Ability to work full-time (40 hours/week) Monday - Sunday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 11:00 pm. The Department is open 365 days a year. It may be necessary, given the business need, it will require to work some holidays. January and April are also PTO blackout months
• 1+ years of Customer Service Representative (CSR) experience OR 1+ years of experience in an office setting, call center setting or phone support role
• Experience with claims processing
• Bilingual fluency in English and Spanish