**Experienced Customer Service Representative - National Remote Health Care Claims and Eligibility Specialist**

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing your life's best work.SM **About UnitedHealthcare** UnitedHealthcare is a leading health insurance company that serves millions of people across the United States. We're committed to helping people live healthier lives and making the health system work better for everyone. Our mission is to provide high-quality, affordable health care to individuals, families, and communities. We believe that everyone deserves access to quality health care, regardless of their background, income, or location. **Job Summary** We're seeking an experienced Customer Service Representative to join our team as a National Remote Health Care Claims and Eligibility Specialist. In this role, you'll play a critical part in delivering exceptional customer service to our members, resolving claims and eligibility issues, and ensuring that our members receive the care they need. As a remote worker, you'll have the flexibility to work from anywhere within the U.S. and enjoy a dynamic, fast-paced environment that's always challenging and rewarding. **Key Responsibilities** * Answer incoming phone calls from customers and identify the type of assistance they need (i.e., benefit and eligibility, billing and payments, authorizations for treatment, and explanation of benefits (EOBs)) * Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems * Own problems through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member * Review and research incoming healthcare claims from members and providers (doctors, clinics, etc.) by navigating multiple computer systems and platforms and verifying the data/information necessary for processing (e.g., pricing, prior authorizations, applicable benefits) * Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates) * Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding * Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance **Essential Qualifications** * High School Diploma / GED or 10 years of equivalent work experience * Must be 18 years of age or older * 2 years of previous or current claims processing experience with UMR CPS (claims processing system) * 1 year of customer service experience in an office or professional setting * Ability to complete on-the-job training for this role during their normally scheduled 8-hour shift Monday - Friday between the hours of 7 am-8 pm CST * Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 7:00 pm CST. It may be necessary, given the business need, to work occasional overtime **Preferred Qualifications** * Familiarity with medical terminology, health plan documents, or benefit plan design * Prior experience utilizing multiple systems/platforms while on a call with a member **Skills and Competencies** * Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs * Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a respectful, timely manner, consistently meeting commitments) * Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member * Flexibility to customize approach to meet all types of member communication styles and personalities * Proficient problem-solving approach to quickly assess current state and formulate recommendations * Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrate personal resilience * Ability to multi-task as well as the ability to understand multiple products and multiple levels of benefits within each product * Ability to work regularly scheduled shifts within our hours of operation, including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule and work over-time as needed **Career Growth Opportunities and Learning Benefits** At UnitedHealthcare, we're committed to helping our employees grow and develop their careers. We offer a range of training and development programs, including on-the-job training, mentorship, and leadership development opportunities. Our employees also have access to a range of benefits, including: * Comprehensive benefits package * Incentive and recognition programs * Equity stock purchase * 401(k) contribution * Opportunities for career advancement and professional growth **Work Environment and Company Culture** As a remote worker, you'll have the flexibility to work from anywhere within the U.S. and enjoy a dynamic, fast-paced environment that's always challenging and rewarding. Our company culture is built on a foundation of respect, empathy, and compassion. We're committed to creating a workplace that's inclusive, diverse, and supportive of all employees. **Compensation, Perks, and Benefits** We offer a competitive salary and benefits package, including: * Hourly rate: $16.54 - $32.55 per hour (dependent on location and experience) * Comprehensive benefits package * Incentive and recognition programs * Equity stock purchase * 401(k) contribution **How to Apply** If you're a motivated and compassionate individual who's passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, to [insert contact information]. We can't wait to hear from you! **Equal Employment Opportunity** 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. **Drug-Free Workplace** UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply for this job