Health Plans Customer Service Advocate

University of Utah; Murray, Northern (UT, KY); Hybrid; USD 32,000 - 46,000; Full time

Job summary

University of Utah Health seeks staff for the Health Plans Department to deliver world class customer service to members and providers. The role handles phone inquiries in a call center, demonstrating empathy, advocacy and expertise, with focus on one-call resolution for benefits and eligibility. It does not provide clinical care.

Responsibilities include explaining claim adjudication, documenting calls, and following up on issues. May respond to emails as needed in a fast-paced environment.

Qualifications

• One year of customer service experience.
• Strong communication and organizational skills.
• Ability to work independently and in a team.

Responsibilities

• Provide world class customer service to members and providers by phone.
• Explain adjudication of claims for deductibles, co-pays, and provider reimbursements.
• Answer questions about benefits and eligibility in a timely manner.
• Document phone calls in the system and follow up when needed.
• Resolve issues from claim adjudication and customer inquiries.
• May monitor and answer emails from customers.

Skills

Customer service

Empathy

Verbal communication

Multi-tasking

Teamwork

Computer literacy

Tools

CRM systems

Job description

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position for use in Health Plans Departments only. The Customer Service position is responsible for providing world class customer service to our members and providers by demonstrating empathy, advocacy and expertise. This position answers phone inquiries in a call center environment, while optimizing accuracy of information, service and quality. The incumbent seeks to optimize the member and provider experience by offering one call resolution by being experts in benefits and eligibility. This position is not responsible for providing care to patients.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Responsibilities

Essential Functions

• Supports and promotes UUHP's mission, vision, values, and goals.
• Contributes to positive and productive team environment.
• Maintains accountability for customer service performance expectations.
• Explains adjudication of claims for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
• Provides prompt customer service to members, providers, billing departments and other insurance companies regarding claims, benefits and eligibility, provider network status, and any other related insurance inquiries.
• Documents phone calls in system and follows up on issues if needed.
• Resolves problems resulting from claim adjudication and customer service phone calls.
• May monitor and answer customer service inquires via email.

Knowledge / Skills / Abilities

• Ability to perform the essential functions of the job as outlined above.
• Demonstrated skills in customer service.
• Ability to work effectively, independently, and as part of a team.
• Strong organization, time management and project management skills and multi-tasking abilities.
• Detail oriented with problem-solving abilities.
• Demonstrated strong communication skills.
• Demonstrated strong computer competency in navigating multiple programs and resources as well as typing.

Qualifications

Required

• One year of experience in Customer Service.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Sitting, Speaking, Standing, Walking

Multi-lingual Candidates Welcomed

EEO Statement

University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations.

All qualified individuals are encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.

University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Aff… The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both.

To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at: www.utah.edu/nondiscrimination/. Online reports may be submitted at oeo.utah.edu/

University is a participating employer with Utah Retirement Systems ("URS"). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics Human Resources at [phone] for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at [phone] or [phone] or Hospitals and Clinics Human Resources at [phone] if you have questions regarding the post-retirement rules.

This position may require the successful completion of a criminal background check and/or drug screen.

Requisition Number 86484
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule 10:30am-7:00pm Monday-Friday
Clinical/Non-Clinical Status