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- Wausau, WI
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Customer Service and Claims Representative - Wausau, WI
UnitedHealth Group • Wausau, WI
Posted 1 month ago
Even if you have no prior experience, we have training classes starting soon to help you build the successful career that you want - apply today! We provide the support and structure, you provide the interest and motivation.
You like working with people. Even more so, you like helping them. This is your chance to join a team dedicated to helping our members and their families every day. In this joint role as a Customer Service and Claims Representative, you'll join us on a mission to not only deliver the best customer service in the health care industry, but the best customer service. Period. Your compassion and customer service expertise combined with our support, training and development will ensure your success. This is no small opportunity. This is where you can bring your compassion for others while doing your life's best work. SM
In this role, you play a critical role in creating a quality experience for the callers that you connect with and those that you correspond with. Every interaction gives you that opportunity to improve the lives of our customers and exceed their expectations. You'll spend the majority of your day by responding to calls from our members and help answer questions and resolve issues regarding health care eligibility, claims and payments. You'll also spend a portion of your time reviewing, researching and processing healthcare claims with the goal to ensure that every claim has a fair and thorough review.
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 (7am to 8pm). It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 115 W Wausau Ave, Wausau, WI 54401.
To learn even more about this position, click here to watch a short video about the job: http://uhg.hr/CustomerFirstRep (Note: these videos are labeled with our internal job title of Customer First Representatives)
- Answer incoming phone calls from customers and identify the type of assistance the customer needs (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 problem 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 verifies 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
- Prefer 1 year prior experience in an office setting, call center setting or phone support role, but not required
- An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in 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
- Proficient problem solving approach to quickly assess current state and formulate recommendations
- Proficient in translating healthcare - related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
- Flexibility to customize approach to meet all types of member communication styles and personalities
- Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilience
- 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 and/or weekends, as needed
- All new hires will be required to successfully complete the Customer Service training classes and demonstrate proficiency of the material
There are several steps in our hiring process - it’s a thorough process because we want to ensure the best job and culture fit for you and for us. In today’s ultra - competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application / job questions). Once you submit your resume, you’ll receive an email with next steps. This may include a link for an online pre - screening test(s) (or what we call an assessment) that we ask you to complete as part of our selection process. You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail. http://uhg.hr/OurApplicationProcess
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.SM
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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