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Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location Phoenix, AZ
Phoenix, Arizona

About this job




Position Description:


Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

Our Customer Service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care.
 
Employees in this position include those responsible for initial Triage of members, Administrative Intake of members or managing the Admission/discharge information post-notification, and working with hospitals and the Clinical team. Function includes managing Incoming calls, managing requests for services from Providers/members, providing information on available Network services and transferring members as appropriate to Clinical staff. Also manages the Referrals process, processes Incoming and Outgoing Referrals, and Prior Authorizations. This function also includes Intake, Notification and Census roles.

Primary Responsibilities:

Respond to Incoming Provider and Enrollee calls.
Resolve Customer Service inquiries 
Provide excellent Customer Service to both Providers and Enrollees.
Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
Receives Care Coordination notification cases for non-clinical assessment/intervention and provides appropriate triage
Processes out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products
Processes notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues
Determines benefit coverage issues based on employer group contracts
Sets up/documents/triages cases for (CCR) Clinical Coverage Review
Ensures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable
Processes letters within DOL time frames
Verifies appropriate ICD-10 and CPT coding usage
Communicates to providers and members benefit determinations within DOL time frames
Assist with faxes and emails.
Moderate work experience within own function.
Some work is completed without established procedures.
Basic tasks are completed without review by others.
Supervision/guidance is required for higher-level tasks.
Other duties as assigned by manager and/or director.

Requirements


Required Qualifications:

High School Diploma/GED
1+ years of professional experience in an office/customer service environment
Experience working with Microsoft Word and Excel
Computer experience including, but not limited to, ability to learn new computer system applications
Flexibility to work outside standard hours of operations due to changing business needs
Preferred Qualifications:

Bachelor's Degree
Professional experience in an Office setting using the telephone and computer as the primary instruments to perform the job duties OR Customer Service experience analyzing and solving customer's problems
Experience working within the Healthcare Industry, Hospital, Physician's Office, or Medical Clinical setting, Medical Terminology, ICD-9 and CPT codes, Medicare and/or Medicaid Services, Call Center environment
Professional experience in a Clerical or Administrative support related role
Experience with Outlook or Lotus Notes
Bilingual with English and SpanishUnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 6, 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.Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.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.