The Customer Service / Claims Representative is responsible for processing medical claims and answering incoming calls from customers while ensuring a high level of customer service and maximizing productivity.
Processes claims according to specified procedures and standards, meeting all position production and quality standards.
Recognizes when to refer complicated claim situations to the various areas, outside firms and organizations. Submits and monitors claims referred to internal support units.
Determines if third party recovery or reimbursable compensation potential exists. Handles complex claim situations. Analyzes and resolves problems from customers and providers. Selects and explains the best solution for the problem.
Respond to complex customer calls
Resolve customer service inquiries which could include:
Benefit and Eligibility information
Billing and Payment issues
Customer material requests
Authorization for treatment
Explanation of Benefits (EOB)
Provide the very best customer service to internal/external customers.
Constantly meet established productivity, schedule adherence, and quality standards
Project work as assigned
1 year of customer service experience analyzing and solving customer problems, OR 1 year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
Authorization to work in the United States
Available to work 40 hours per week anytime within the operating hours of the site
Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Ability to navigate a computer while on the phone
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Ability to remain focused and productive each day though tasks may be repetitive
1 year medical claims, billing, ICD9, CPT, and/or HCPC codes preferred
Physical Requirements and Work Environment:
Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, weâ€™re doing a lot of good.
Through our family of businesses and a lot of inspired individuals, weâ€™re building a high-performance health care system that works better for more people in more ways than ever. Now weâ€™re looking to reinforce our team with people who are decisive, brilliant â€“ and built for speed.
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.
We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we...