Customer Service Specialist (Claims) - San Antonio, TX - Full-time / Part-time

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UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good. Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant, and built for speed.

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.

Primary Responsibilities:

• 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

Required Qualifications:

• High School Diploma or GED


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


• Excellent verbal communication skills and customer service skills


• Working knowledge of Microsoft Office applications including Excel, Access and Word

Preferred Qualifications:

• Associate's Degree 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

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.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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.