Experienced National Remote Customer Service and Claims Representative - Delivering Exceptional Healthcare Experiences through Compassionate Support and Effective Claims Processing

Introduction to UnitedHealthcare At UnitedHealthcare, we are driven by a profound mission to simplify the healthcare experience, foster healthier communities, and dismantle barriers to quality care. Our work has a direct and profound impact on the lives of millions, striving to make healthcare more responsive, affordable, and equitable for all. If you're ready to embark on a journey that makes a tangible difference in people's lives, we invite you to join us in building the healthcare system of tomorrow. About the Role We are seeking an experienced and compassionate Customer Service and Claims Representative to join our team. This role offers the unique opportunity to work remotely from anywhere within the U.S., providing flexibility and work-life balance. As a Customer Service and Claims Representative, you will be at the forefront of delivering exceptional customer experiences, ensuring that our members and their families receive the support and care they deserve. Your role will be multifaceted, involving both customer service and claims processing, where your ability to empathize with our members, understand their needs, and provide timely and effective solutions will be paramount. Key Responsibilities Answer incoming phone calls from customers, identifying the type of assistance needed, whether it pertains to benefits and eligibility, billing and payments, authorizations for treatment, or explanations of benefits (EOBs). Engage actively with customers, asking pertinent questions, listening attentively to their concerns, and documenting all necessary information in our computer systems. Own the problem-solving process for our customers, resolving issues in real-time or through comprehensive and timely follow-up, ensuring that every interaction ends with a satisfied member. Review and research incoming healthcare claims from members and providers, navigating multiple computer systems and platforms to verify data and ensure accurate processing. Apply the proper benefits to each claim, adhering to established processes and procedures, including claims processing policies, grievance procedures, state mandates, CMS/Medicare guidelines, and benefit plan documents. Communicate clearly and collaboratively with members and providers to resolve issues, using simple language to ensure understanding and empathy. Meet performance goals in efficiency, accuracy, quality, member satisfaction, and attendance, contributing to the team's overall success and growth. Essential Qualifications To excel in this role, you should possess: A High School Diploma/GED or equivalent work experience. Be at least 18 years of age. Previous experience in claims processing, preferably with UMR CPS (claims processing system), although we provide comprehensive training for the right candidates. At least 1 year of customer service experience in an office or professional setting, demonstrating your ability to work with people and provide exceptional support. Flexibility to work any of our 8-hour shift schedules during our normal business hours and occasional overtime as needed. Ability to complete on-the-job training during your scheduled shifts. Preferred Qualifications While not required, the following qualifications are highly valued: Familiarity with medical terminology, health plan documents, or benefit plan design, which can enhance your understanding and support of our members. Prior experience utilizing multiple systems/platforms while on a call with a member, demonstrating your ability to multitask and navigate complex information. Telecommuting Requirements As this role is remote, you must: Ensure all company-sensitive documents are kept secure. Have a dedicated work area that is separated from other living areas and provides information privacy. Live in a location with a reliable, high-speed internet connection approved by UnitedHealth Group. Soft Skills To succeed in this position, you should demonstrate: Strong computer skills, including proficiency in Windows PC applications and the ability to learn new programs quickly. A compassionate and customer-centric approach, with the ability to build rapport and respond to customers' needs effectively. Excellent listening and problem-solving skills, with the ability to collect relevant information, determine immediate requests, and identify future needs. Flexibility in communication styles to meet the diverse needs of our members. Proficient conflict management skills to resolve issues in stressful situations while demonstrating personal resilience. Ability to multitask, understand multiple products and benefits, and work in a fast-paced environment. Career Growth and Learning Benefits At UnitedHealth Group, we are committed to your growth and development. You will have access to comprehensive training programs, career advancement opportunities, and a supportive environment that encourages learning and innovation. Our goal is to help you achieve your professional aspirations while making a meaningful impact in the lives of our members. Work Environment and Company Culture We pride ourselves on a culture that values diversity, equity, and inclusion. Our mission to help people live healthier lives is reflected in our commitment to mitigating health disparities and enabling equitable care. We believe that a diverse and inclusive workplace fosters creativity, innovation, and collaboration, leading to better outcomes for our members and the communities we serve. Compensation, Perks, and Benefits We offer a competitive compensation package, including a salary range of $16.54 - $32.55 per hour for eligible residents, comprehensive benefits, incentive and recognition programs, equity stock purchase, and 401k contribution. Our benefits are designed to support your well-being, financial security, and professional growth, ensuring that you can thrive both personally and professionally. Conclusion If you are passionate about delivering exceptional customer experiences, have a strong desire to make a difference in people's lives, and are looking for a challenging yet rewarding career, we invite you to apply for the Customer Service and Claims Representative position. Join our team at UnitedHealthcare and embark on a journey that combines personal fulfillment with professional growth, all while contributing to the well-being of our members and the advancement of the healthcare system. Apply now and start doing your life's best work! Apply for this job