Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/member, receipt and data entry of information, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification and census roles. Our mission is to help people live their lives to the fullest. Our values are Integrity, Compassion, Relationships, Innovation, and Performance.
- Anticipates customer needs and proactively develops solutions to meet them
- Serves as a key resource on complex and/or critical issues
- Solves complex analyses and problems and develops innovative solutions
- Forecasts and plans resource requirements (applicable to specific areas)
- Authorizes deviations from standards
- May lead functional or segment teams or projects
- Motivates and inspires other team members
- Build relationships across departments to provide the best service to members
- Build a strong understanding of the medical/insurance industry
- Prioritizes and organizes own work to meet agreed upon deadlines
- Monitor process performance and initiate process control plans when indicated
- Engages and documents over the phone providing quality consumer focused services
- Conducts audits of regulatory requirements, staff quality, turn-around times to meet business and client requirements, or Engagement recorded calls (applicable to specific areas)
- Effectively enroll members to the appropriate programs based on member needs, eligibility and benefits
- Communicate and educate staff regarding individual team opportunities for improvements
- Develop targeted audits to monitor performance post-implementation (applicable to specific areas)
- Identify training and development opportunities for staff as a result of audit performance (applicable to specific areas)
- Perform administrative support for the department/area.
- High School Diploma or GED is required.
- 2+ years of Healthcare, Health Insurance, or Benefits
- 2 + years professional experience in an office setting using the telephone and computer as the primary instruments to perform the job duties
- 2+ years of experience in a customer service environment and/or call center experience
- 2 + years professional experience in a clerical or administrator role
- Intermediate MS/Office (Word, Excel & Outlook) is required.
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
- Medical Terminology/Coding (ICD-9 and CPT)
- Hospital, physician, or medical clinical
- Medicare and/or Medicaid
- Bilingual (English / Spanish) is preferred.
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
UnitedHealth Group - 19 months ago
When you work to better people’s lives, one of those lives will always be yours.
We have modest goals: Improve the lives of...