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.
A typical day for a Peoples Health Member Services Representative begins with representatives taking to their work stations and organizing them and setting up their resources to maximize their success in handling calls. That includes reviewing emails, the intranet, the department’s dashboard, and team performance from the previous day. After ensuring preparedness, representatives log onto the phone system and make themselves available to assist callers.
Some days are busier than others and require you to hit the ground running and handle a lot calls while remaining engaged, empathetic, and helpful to the caller. Often times callers are dealing with health and / or financial issues that add a sense of urgency to their requests, and you have to maintain a balance between advocating for members, and business processes that make the company successful. At all times, the customer is at the center of what you do. On slower days, you follow up on outstanding action items that you routed to other departments, and conduct follow - up calls with members to close out their contact. You’re always learning something new and expanding your knowledge of the industry and the population of members we serve. It can be a very rewarding experience.
Handle inquiries, concerns, complaints, grievances and appeals in a professional manner by listening to the member and showing respect. When appropriate, the representative takes action to resolve complaints to ensure member retention and satisfaction by following department guidelines or contacts immediate supervisor for intervention
Educate members, customers (internal / external) while effectively promoting Peoples Health products, services, and policies on the telephone as well as face - to - face communication
Act in accordance with Peoples Health vision and values. Participate and support development programs, active in staff meetings, and performs company educational offerings as well as demonstrating the willingness to work as a team member when needed for additional tasks to ensure excellent service
Ensure that supplies are sufficient to perform their duties, maintain equipment in proper place after usage and maintain workspace in an orderly fashion
Act as an efficient liaison for the member and effectively documents 100% of their communication in the service module achieving a clear link between subject line, category, sub - category and free text
Handle requests as needed for transportation to participating providers and return trip requests
Properly utilize the transportation database
Generate denial letters when needed. When requested, prepare daily schedules for vendors and reporting requirements.
Familiarize with standard healthcare concepts, practices, and procedures as they relate to claims adjudication and managed care
Complete special assignments in an accurate and efficient manner with little intervention from management
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.
High School Diploma / GED (or higher)
Experience in a call center environment or related customer service field
Prior healthcare experience
Basic computer navigation skills with experience in a Windows environment
Experience with Microsoft Office Suite: Microsoft Excel (enter information, save files, navigate through worksheet), Microsoft Word (create documents), Microsoft Outlook (organize email)
Experience with Internet (utilize web - based internal applications)
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well - being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do 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.
Keywords: UHG, UHC, M&R, PeoplesHealth, member services representative, call center, healthcare, Amisys