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UnitedHealth Group Senior Customer Service Representative - San Antonio, Texas in San Antonio, Texas

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

Challenge can often be its own reward. But why settle for just being challenged when you can also be nurtured, mentored and supported as you make an impact in a fast paced career? At UnitedHealthcare, part of the UnitedHealth Group family of businesses, you can have all of the above, everyday. Now, you can take advantage of some of the best training and tools in the world to help serve our existing and new customers.

The Sr. Customer Service Representative provides service to providers who have claims related questions by promptly responding to their concerns in a timely manner. This position will assist in resolving payment/adjudication questions or concerns by insuring issues are presented to the appropriate department for resolution and/or will resolve payment/adjudication questions at the time the call is received; explaining calculation methodology, contract terms, procedures, etc on a limited basis.

Primary Responsibilities:

  • Clearly communicates claims status, payment or non-payment information related to claim in question by the customer

  • Informs and assists callers with the claims appeals process, if necessary

  • Enters detailed information into a tracking system to ensure that all priority issues are handled within established time frames and proactively notifies caller of the expected time frame for resolution

  • Answer customer service lines promptly and professionally and maintain at least a 95% response time

  • Maintains quality standards as required for position

  • Demonstrates excellent customer service by determining the reason for the call, acknowledging the callers concerns and resolve concerns and/or explain action to be taken within the expected time line for resolution

  • Presents a pleasant voice to all callers regardless of the stressful nature of the situation

  • 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 / GED

  • 2+ years of experience supporting a health care or customer service environment

  • Working knowledge of Microsoft Office applications with the ability to create, edit, etc., in Excel, Access, and Word

  • You will be asked to perform this role in an office setting or other company location.

  • Employeesare required to screen for symptoms using the ProtectWell mobile app,Interactive Voice Response (i.e., entering your symptoms via phone system) or asimilar UnitedHealth Group-approved symptom screener prior to entering the worksite each day, in order to keep our work sites safe. Employees must comply withany state and local masking orders. In addition, when in a UnitedHealth Groupbuilding, employees are expected to wear a mask in areas where physicaldistancing cannot be attained

  • Youwill be asked to perform this role in an office setting or other companylocation

Preferred Qualifications:

  • Associate's degree (or higher) in Business or Information Systems

  • 1+ years of experience working in a Healthcare claims environment

  • Knowledge of HCFA guidelines and Medicare claims payment rules and claims policies and procedures

  • Knowledge of PSIMED system applications and interactions

  • Must have excellent verbal communication skills and customer service skills

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 240,000+ 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: Optum, WellMed, Customer Service, Call Center, Claims, Sr. Customer Service Representative, San Antonio, TX, Texas