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Company Name : UnitedHealth Group
Location : Dayton, OH 45431
Position : Provider Customer Service Representative – Work from Home
Job Description : $1000 Sign On Bonus For External Candidates
If you are located within the state of Ohio, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.
Provider Service contact center advocates support the millions of providers who care for our 50 million members. The responsibilities completed by provider service advocates reduces downstream follow-up and research members. This, in turn, reduces downstream workloads for other service organizations supporting members across the enterprise.
PSO contact center advocates serve healthcare professionals who are fluent in healthcare terminology, often with many years of experience across multiple payers. These healthcare professionals expect to receive timely, confident, and thorough responses to questions that span the full continuum of care delivered to a member, including but not limited to:
Benefits and eligibility
Billing and payments
Clinical authorizations
Explanation of benefits
Behavioral health.
Meeting this expectation requires PSO contact center advocates to possess a deep knowledge of UnitedHealthcare’s products, procedures, and billing practices to ensure that the provider receives an excellent experience during their encounter. New contact center advocates complete extensive new-hire training over a 12-13 week period and ongoing education to ensure their thorough preparedness to meet and exceed provider expectations for each call encounter.
Role Overview
Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues
Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices)
Seek to understand and identify the needs of the provider, answering questions and resolving issues (e.g. benefits and eligibility, billing and payments, clinical authorizations, explanation of benefits, behavioral health)
Research and dissect complex prior authorization and claim issues and take appropriate steps to resolve identified issues to avoid repeat calls, escalations, and provider dissatisfaction
Collaborate effectively with multiple internal partners to ensure issues are resolved and thoroughly communicated to providers in a timely manner
Strong multitasking to effectively and efficiently navigate more than 30 systems to extract necessary information to resolve and avoid issues across multiple lines of business (C&S, M&R, E&I) provider types, and call types
Influence providers to utilize self-service digital tools assisting with navigation questions and selling the benefits of the tool including aiding in faster resolution
This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 8:00pm EST. It may be necessary, given the business need, to work occasional overtime.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Primary Responsibilities:
Phone Support and Provider Issue Resolution
Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices)
Seek to understand and identify the needs of the provider, answering questions and resolving issues (e.g. benefits and eligibility, billing and payments, clinical authorizations, explanation of benefits, behavioral health)
Research and dissect complex prior authorization and claim issues and take appropriate steps to resolve identified issues to avoid repeat calls, escalations, and provider dissatisfaction
Ask appropriate questions and listen actively to identify underlying questions/issues (e.g., root cause analysis)
Gather appropriate data/information and perform initial investigation to determine scope and depth of question/issue
Collaborate effectively with multiple internal partners to ensure issues are resolved and thoroughly communicated to providers in a timely manner
Meet performance goals established for the position optimizing provider satisfaction, first call resolution, and attendance
Learning new skills will be required over time in this role as the function evolves and business needs change
Provider Experience and Service Excellence
Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues
Influence providers to utilize self-service digital tools assisting with navigation questions and selling the benefits of the tool including aiding in faster resolution
Meet performance goals established for the position optimizing provider satisfaction, first call resolution, and attendance
Maintain ongoing communications with callers during the resolution process to communicate status updates and other required information
Maintain focus on provider interactions without being distracted by other factors
Identify inaccurate/inconsistent information found in systems/tools, and communicate to appropriate resources
Business Acumen and Industry Knowledge
Possess a deep knowledge of UnitedHealthcare’s products, procedures, and billing practices to ensure that the provider receives an excellent experience during their encounter
Demonstrate knowledge of applicable health care terminology
Maintain knowledge of information/process changes due to healthcare industry changes (e.g., regulatory/governmental reforms, innovations, process improvements)
Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements)
Continuous Learning
Learn new skills as the function evolves and business needs change
Demonstrate knowledge of established workflows and support processes
Review/analyze phone support data/metrics and communicate patterns/trends to internal stakeholders, as needed (e.g., leadership, Subject Matter Experts, business partners)
Provide training/mentoring to other team members, as needed (e.g., new-hires, refresher training)
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 (or higher) OR equivalent work experience
Minimum of 2+ years of combined education, work and/or volunteer experience
Preferred Qualifications:
Health Care/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design)
Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)
Sales or account management experience
Customer Service experience
Telecommuting Requirements:
Reside within the state of Ohio
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Ability to keep all company sensitive documents secure (if applicable)
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
Careers with UnitedHealthcare . Let’s talk about opportunity. Start with a Fortune 10 organization that’s serving more than 85 million people already and building the industry’s singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near – obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they’re found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that’s second to none. This is no small opportunity. It’s where you can do your life’s best work. SM
**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.
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.
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