Customer Service Representative - San Antonio, TX - Call Center - Claims Experience Preferred - Full-time / Part-time

WellMed is now part of the OptumHealth division under the greater UnitedHealth Group umbrella.

WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services.  Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.

Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness.  We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors.  Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.

Job Summary

The Customer Service Specialist provides expert service to providers and patients who have claims related questions by promptly responding to their concerns in a timely manner.  In addition, this position will resolve payment/adjudication questions at the time the call is received; explaining calculation methodology, contract terms, procedures, etc.

Essential Job Functions

• Clearly communicates claims status, payment methodology, contract terms, procedures, etc. to customer. 


• Identifies trends in errors or inquiries and reports these to appropriate personnel.


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


• Develops a tracking system to ensure that all priority issues are handled within established time frames and proactively notifies customers of anticipated delay.


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


• Demonstrate 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. 


• Performs research on complex claim inquiries and expertly re-examines claims. 


• Serves as a resource to medical group staff, network providers, health plan representatives and claims staff.


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


• Performs all other related duties as assigned.

This position is located in San Antonio, TX

• High School Diploma or GED required.


• Two years experience in a health care or managed care customer service environment.


• Must have excellent verbal communication skills and customer service skills. 


• Intermediate Proficiency of Microsoft Office applications including Excel and Word.

Preferred Education, Experience & Skills

• Associate's Degree in Business or Information Systems preferred. 


• One to two years experience working in a Healthcare claims environment preferred.


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

Physical & Mental Requirements:

Ability to lift up to 25 pounds

Ability to sit for extended periods of time

Ability to use fine motor skills to operate office equipment and/or machinery

Ability to receive and comprehend instructions verbally and/or in writing

Ability to use logical reasoning for simple and complex problem solving

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.