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Workers Comp Ops Bill Services Customer Service Representative - Tampa, FL

12/08/2018Call Center
Job Location:
Tampa, FL
Metro Area:
FL - Tampa
Company Name: UnitedHealth Group
Website:  Click to Visit
UnitedHealth Group
Don't wait to apply? We have training classes starting soon that are designed to set you up for success! You want more challenge. You want more opportunity. Even more, you want the chance to make an impact the lives of others. We want more people like you. When you join us as a Customer Service Advocate for UnitedHealthcare, you'll have the opportunity to make a difference in the lives of our health plan members each day as they look to you as their trusted advisor and advocate. You'll be empowered to compassionately deliver an exceptional experience to between 50 to 70 callers per day always remembering that there is a real person on the other end of the phone who is looking for help, guidance, and support. You'll help them make informed decisions about their care services by answering their questions, resolving their issues or helping them enroll in and / or select a health plan. You'll do this by developing and maintaining a productive relationship and interaction with all callers, while providing personalized, and consultative education and information. Here, you'll join us on a mission to deliver the best customer service in the health care industry. Period. Your compassion and customer service expertise combined with our support, training and development will ensure your success. This is no small opportunity. This is where you can bring your compassion for others while doing your life's best work.  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. To learn even more about this position, hear from other Customer Service Advocates. Click here to watch a short video about the job: (Note: these videos are labeled with our internal job title of Health Advisor)    Primary Responsibilities: Review and reprice 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 transactionsResearch 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 necessaryUnderstand 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 reportingRespond 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


Requirements: High School Diploma / GED (or higher) 1+ years Customer Service experience 1+ years of Pharmacy or Workers Compensation claims experience Experience using MS Excel to open, edit, sort / filter and save documents Experience using MS Word to open, edit and save documents 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 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.SMDiversity 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.Keywords:  UnitedHealth Group, OptumRX, training class, customer service representative, customer service, CSR, Pharmacy, PBM, Pharmacy Benefit Management, inbound calls, Call Center
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