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Customer Service and Claims Representative – Remote

UnitedHealth Group

This is a Part-time position in Remote- US posted October 19, 2021.

Location: Remote – US

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work.SM

Even if you have no prior experience, we have training classes starting soon to help you build the successful career that you want – apply today! We provide the support and structure; you provide the interest and motivation.

You like working with people. Even more so, you like helping them. This is your chance to join a team dedicated to helping our members and their families every day. In this joint role as a Part-Time Customer Service and Claims Representative, you’ll join us on a mission to not only deliver the best customer service in the health care industry, but the best customer service. Period. Your compassion and customer service expertise combined with our support, training and development will ensure your success. This is no small opportunity. This is where you can bring your compassion for others while doing your life’s best work. SM

In this role, you play a critical role in creating a quality experience for the callers that you connect with and those that you correspond with. Every interaction gives you that opportunity to improve the lives of our customers and exceed their expectations. You’ll spend the majority of your day by responding to calls from our members and help answer questions and resolve issues regarding health care eligibility, claims and payments. You’ll also spend a portion of your time reviewing, researching and processing healthcare claims with the goal to ensure that every claim has a fair and thorough review.

This position is part-time (Employees are required to have flexibility to work any of our 3-6 hour shift schedules during our normal business hours of (9:00am – 3pm CST).

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • 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
  • Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
  • Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
  • Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
  • Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
  • Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High school diploma / GED (or higher) OR 10+ years of equivalent working experience
  • All new hires will be required to successfully complete the Customer Service training classes and demonstrate proficiency of the material

Preferred Qualifications:

  • 1+ years prior experience in an office setting, call center setting or phone support role

Soft Skills:

  • Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner, consistently meeting commitments)
  • Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
  • Proficient problem-solving approach to quickly assess current state and formulate recommendations
  • Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
  • Flexibility to customize approach to meet all types of member communication styles and personalities
  • Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilience
  • Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Colorado Residents Only: The hourly range for Colorado residents is $15.00 to $22.02. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

Additional Job Detail Information

Requisition Number 1004001

Business Segment UHC Benefit Ops – E&I Ops

Employee Status Regular

Job Level Individual Contributor

Travel No

Additional Locations

  • Phoenix, AZ, US
  • Hartford, CT, US
  • Tampa, FL, US
  • Minneapolis, MN, US

Overtime Status Non-exempt

Schedule Part-time

Shift Day Job

Telecommuter Position Yes