POSITION DESCRIPTION

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies. All the while, you'll be building your career with a leader and reaching for the highest levels of performance as you do YOUR LIFE'S BEST WORK.(SM)

When you are in the business of health care, you're in the business of people. At UnitedHealth Group we want every customer experience to be distinctly personal. The challenge is complex. When people call us for help, their focus is on getting the best care possible. We help them understand their benefits and their options. This part of their lives matters a lot to them and it matters just as much to us. Our customer service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care. As PROVIDER INQUIRY CALL CENTER REPRESENTATIVE you will be accepting and directing all incoming phone calls according to policy and procedures and department productivity and quality standards. Resolves routine to moderately complex issues, refers appropriately to Team Lead and/or Supervisor as needed.

PRIMARY RESPONSIBILITIES:

• Answer in-coming calls from the Provider Inquiry Line and the Fraud Hotline. Incoming calls can be from Providers questioning claim status, review status, appeal status and/or reporting of fraud
• Logging of all in - coming calls in a Call Tracking Documentation System
• Maintains accuracy standards of 99% or greater
• Maintains adherence standards of 95% or greater
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Works independently and as part of a team
• Act as a resource for others

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 or higher
• 1+ year of call center experience
• Experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
• Ability to work 40 hours / week during standard business operating hours Monday - Friday from 9am - 7pm AST
• Fully Bilingual Spanish/English proficiency

PREFERRED QUALIFICATIONS:

• Knowledge of medical terminology
• Experience within the healthcare industry
• Experience in claims
• Proficiency with MS Office Suite

CAREERS WITH OPTUM. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do YOUR LIFE'S BEST WORK.(SM)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.