Customer Service Associate - Waterloo, IA

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.



Responsibilities:


Answer simple incoming calls from providers and members while ensuring a high level of customer service while maximizing productivity with minimum downtime.


Resolve basic types of customer service inquiries including: Benefits, Eligibility, Provider look - up, Authorization, Basic member admin calls and Member material requests.


Locate Explanation of Benefits (EOB).


Participate in proactive outbound call program (i.e., welcome calls) to ensure customer satisfaction, when applicable.


Provide excellent customer service to both members and providers by:


Quickly and accurately identifying and assessing individual provider and member needs and taking appropriate action steps to satisfy those needs.


Solve problems systematically, using sound business judgment and follow through on commitments.


Respond to customers in a polite and courteous manner, especially in stressful situations.


Project patience, empathy, caring, and sincerity in voice tone and words.


Establish rapport over the phone quickly, and remain positive and upbeat over prolonged periods of customer service.


Express thoughts and information clearly and succinctly.


Inspire confidence and positively influence the behavior, actions, and thoughts of others.


Communicate unpleasant or negative information in a tactful manner.


Ensure the average call monitoring score over the previous six months meets or exceeds quality standards.


Ensure proficiency in all product lines instructed in classroom training.


Consistently meet established productivity, schedule adherence and quality standards.


Adhere to quality improvement initiatives. Learn new skills, and retain large amounts of information, facts, rules, procedures, and codes.


Be flexible, adjust quickly, and react positively to change.


Demonstrate the ability to build and maintain productive working relationships with others and contribute as an effective team member.


Establish and maintain control of inbound calls using a well-organized call structure. Respond in writing to member/provider basic correspondence using pre-approved letters.


Access Lotus Notes for incoming mail and respond to inquiries. Use UHG technology to track, route and retrieve information (e.g., PC-ORS, iBAAG).


Demonstrate strong data entry skills and proficiency use of a PC, and be able to locate and interpret complex information from a number of databases.


Be proficient in the use of telephone equipment, including headset as well as the commands required to integrate screen and system functions.


Ability to process least complex administrative tasks includes. UHG product knowledge (e.g., basic understanding of plan design).


Customer specific knowledge of plan components (benefits). UNET system(s) and workflow knowledge (electronic - EDI, Keying Vendors, United Front-end, EPD). UNET system(s) and workflow knowledge (CES, EDS screens, claim routing, TOPS / UNET, claim queues).


Ability to process claim with coding discrepancies, use of pend, remark, diagnosis , service, override, POS, attachment and denial codes, and to locate claim reference materials (e.g., Preference, iBAAG).


Job Requirements:

Requirements:
Ability to identify when to route claims to internal or national queues, and to process claims requiring suspect duplicate resolution.
Strong communication skills.
Attention to detail.
Quality focused.
Decision making skills.
Organizational skills.
Problem solving.
Team player.
Flexibility in following a schedule provided by the Workforce Manager.
High school diploma or equivalent work experience.
Customer service background preferable.
PC skills (Word/Excel) desired.
Strong customer service orientation.
Bilingual a plus

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.