Senior Customer Service Representative

Optum is a global organization that delivers care aided by technology to help people live healthier lives. The Senior Customer Service Representative delivers compassionate customer service, handles complex and escalated healthcare-related issues, supports team members as a subject matter expert, and helps customers navigate benefits, billing, authorizations, and related resources.

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 old OR older
• 1+ years of customer service experience OR experience in a medical office, health care, call-center or office setting analyzing and solving customer problems
• Experience with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Experience translating health care-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
• Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30 am - 4:00 pm PST. It may be necessary, given the business need, to work occasional overtime
• 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
• Proficient conflict management skills including the ability to resolve stressful situations
• Demonstrated ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
• Health care experience
• Bilingual fluency in English and Spanish
• Knowledge of billing/finance and eligibility processes, practices and concepts