Energize your career with one of Healthcare's fastest growing companies.

You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UNITEDHEALTH GROUP is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: OPTUM - a growing part of our family of companies that make UNITEDHEALTH GROUP a Fortune 6 leader.

OPTUM 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 healthcare 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.

Positions in this function are responsible for providing expertise and customer service support to members, customers, and / or providers. Direct phone - based customer interaction to answer and resolve a wide variety of inquiries. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement

PRIMARY RESPONSIBILITIES:

• Understand and communicate the review and repricing of pharmacy bills according to regulatory guidelines and in light of any client - specified special instructions, checking potential duplicates, reading notes sent electronically from adjusters and reading medical notes when necessary to make decisions on relatedness based on claim notes and diagnosis codes
• Communicate with pharmacies, providers and physician-dispensed networks to assist in real - time with transaction processing, liaising with adjusters to determine patient eligibility, identify and resolve processing issues and proactively minimize blocked transactions
• Research and reevaluate previously audited claims returned by the provider for additional consideration; corresponds with carriers and providers via email and telephone and correct the billing as necessary
• Understand rules and regulations for each carrier, working with leadership to develop new partner - specific guidelines and data to increase network penetration
• Correct and ensure accurate data for billing and state reporting
• Respond to customer inquiries concerns and review claims for any special instructions
• 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: queue inventory, productivity, call quality, customer satisfaction and attendance
• Must initiate federal clearance within first 90 days

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 GED (or higher)
• 1+ year Customer Service experience
• 1+ years of Pharmacy or Workers Compensation claims experience
• Experience using Microsoft Excel ( open, edit, sort / filter and save spreadsheets)
• Ability to work regularly scheduled shifts within our hours of operation of 8am - 5pm, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over - time and / or weekends, as needed

PREFERRED QUALIFICATIONS:

• Associate's Degree ( or higher)
• Experience using Microsoft Word (open, edit and save documents)
• Health care experience

SOFT SKILLS:

• Ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manners, consistently meeting commitments)
• 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

OPTUMRX is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do. If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing 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.