Customer Service Representative Senior

UnitedHealth Group; Dallas (TX); Remote; USD 51,577,000 - 91,693,000; Full time

Job summary

UnitedHealth Group is seeking a remote Customer Service Representative to handle Medicare and HMO related calls in a full-time role. You will receive and log customer concerns, coordinate with physicians and health plans, and ensure accurate contract interpretation.

This position offers training and potential overtime based on business needs. This role requires strong communication, Excel/Word proficiency, and the ability to work 8-hour shifts during Pacific business hours.

Qualifications

• High School Diploma or equivalent required.
• 1+ years of Medicare/HMO experience preferred.
• 1+ years of claims processing or customer service experience.
• Experience with spreadsheet applications (Excel/Access) and with contracts interpretation.

Responsibilities

• Answer customer concerns via phone and resolve per guidelines.
• Act as liaison between physician, health plan, and IPA staff.
• Interpret provider/health plan contracts for accurate responses.
• Log issues in the Customer Service Tracking database for follow‑up.

Skills

Customer service

Communication

Microsoft Excel

Microsoft Word / Outlook

Education

High School Diploma / GED

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30 am - 4:00 pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer 2 weeks of paid training. The hours of training will be based on your schedule or will be discussed on your first day of employment.

Primary Responsibilities:

• Occasional shadowing/training of newly hired staff
• Receives and records customer concerns via phone. Acts to resolve concerns in accordance for corporate guidelines and standards for all areas of claims, authorizations and IPA functionality.
• Functions as liaison between physician, health plan, and IPA staff
• Ability to interpret provider and health plan contracts to ensure accurate responses to calls
• Log issues into the Customer Service Tracking database that require resolution and/or follow‑up
• Plan and organize workload to ensure efficient and timely resolution of issues.
• Respond to callers with the resolution of issues in a timely manner in accordance with the guidelines set by the department
• Participates in telephonic surveys as required by management
• Follow and support the guidelines set by the department and organization to ensure overall goals are met
• Maintain minimum standards for the department for quality and quantity of calls received
• Foster interpersonal relationships, showing empathy and understanding towards staff, protecting individual self‑esteem. Understand own impact on others; interact effectively with peers, subordinates, and supervisors
• Any other assigned duties as delegated by the Customer Service Supervisor

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 equivalent work experience
• Must be 18 years of age OR older
• 1+ years of experience in Medicare and HMO environment
• 1+ years of claims processing OR claims customer service experience
• 1+ years of authorization / referral processing experience
• 1+ years of customer service experience
• Experience with spreadsheet applications such as Microsoft Excel and / OR Microsoft Access
• Experience with and knowledge of standard billing practices
• Experience interpreting provider and health plan contracts
• Experience using Windows programs including Microsoft Word, Microsoft Outlook and Microsoft Excel
• Ability to work full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30 am - 4:00 pm PST. It may be necessary, given the business need, to work occasional overtime.

Telecommuting Requirements:

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

Soft Skills:

• Excellent communication and presentation skills
• Good grammar, voice and diction
• Strong organizational and prioritization skills
• Able to represent the company in a professional and positive manner
• Ability to retain composure in stressful situations
• Ability to de‑escalate potential volatile situations
• Ability to identify confidentiality and its requirements (HIPAA)
• Strives to be a team player
• Must have excellent, writing, punctuation, grammatical and spelling skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far‑reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full‑time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income‑deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.