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Customer Service Team Lead - San Antonio, TX

UnitedHealth Group | San Antonio, TX | 09/14/2021

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

The Claims Customer Service Lead will assist the Claims Customer Service Supervisor in managing the day-to-day functions of the Customer Service Department, to include workflow management and CS technical support. The CS Lead assists in monitoring schedule adherence and call quality to meet departmental goals. The CS Lead's primary function will include responsibility for coaching and assisting team members through difficult calls, providing claims knowledge and technical support as necessary. They will have primary responsibility to ensure that all escalated and priority phone inquiries are manage appropriately.

Primary Responsibilities:
  • Performs Quality Review of team member call performance and evaluates calls in accordance with established departmental policies and procedures
  • Identifies coaching and training needs of Customer Service Staff related to call performance
  • Makes decisions on minor schedule changes ensuring that minimum staff is available to meet CS targets
  • Responds appropriately to provider, member, and other inquiries via telephone correspondence, in compliance with all corporate policy and procedures, performance standards and regulatory guidelines
  • Acts as first level contact for escalated calls
  • Provide continuous monitoring of phone systems, call volume and employee work status in order to provide sufficient phone coverage
  • Manage the daily work activities of all team members to include daily tasks and special projects, to maintain established service levels
  • Provide initial onboard, ongoing training and ad hoc assistance to team members for all system functions, team policies and department procedures used in the claims process
  • Documents, investigates, and resolves customer concerns in a competent and expedient manner demonstrating respect and courtesy for callers at all times
  • Documents and follows-up on all inquiries, utilizing on-line systems and procedures, according to established guidelines
  • Contributes to the overall attainment of Department and Corporate goals by assisting with other projects, reports, and duties, as assigned based on business need
  • Communicates workflow issues, benefit or procedural changes to staff and upstream management as needed
  • Train the team to avoid HIPAA Violations, to monitor that such violations do not occur and to report any and all violations if necessary
  • Contributes in design and implementation of applicable System upgrades
  • Communicates ideas for improvements and increased efficiency within the CS Department
  • Develops, distributes, and maintains departmental reports and logs as assigned
  • Assists the Claims Customer Service team with inbound calls as needed when call volumes are elevated, or team is short staffed
  • Performs all other related duties as assigned


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
  • 5+ years of experience supporting a health care or customer service environment
  • Knowledge of Medicare requirements
  • Willingness to work irregular hours on occasion


Preferred Qualifications:
  • 2+ years of experience with Medicare Advantage Plan or Medicare claims requirements
  • Ability to provide excellent customer service to a varied customer base
  • Ability to navigate multiple systems
  • Ability to work in a fast-paced environment


UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 380,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do 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.

Job Keywords: Customer Service Supervisor, Team Lead, Customer Service Team Lead, San Antonio, TX, Texas

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September 25, 2021