Customer Service Representative - Kingston, NY

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.



Job Responsibilities:
Satisfy members, providers and clients with the quality of service received by responding courteously and accurately to all phone inquiries relating to eligibility issues, explanation of benefits and claims issues.
Forward complex issues to the next level when necessary and appropriate.
Respond to members, providers and clients regarding eligibility verifications for member and providers, explanation of benefits, coordination of benefits and claims inquiries.
Fax eligibility confirmation from PC.
Respond to:
request for a list of providers
providers' questions
request for member / provider materials by completing the appropriate supply form.
Ensure a timely and accurate response to callers utilizing Interactive Voice Response system by retrieving messages and returning calls when appropriate.
Guarantee members receive quality of care and providers are adequately paid capitation by assigning members to providers' offices.
Confirm accuracy of information given to members, providers and clients.
Initiate an MPR (Member / Provider Resolution) when an issue cannot be resolved immediately and routing to the appropriate staff person by close of business.
Provide written confirmation of members' eligibility by completing an eligibility confirmation form when member has not appeared in most recent eligibility list.
Initiate request to reissue check for subscribers and providers.
Ensure members receive mailing by researching inaccurate addresses on returned mail and correcting the mailing within 24 hours of receipt.
Promote use of Interactive Voice Response System by informing callers of is availability and capabilities.
Alert management of repeat phone calls due to issues that have not been resolved within standards.
Assist in providing excellent customer service by performing ad hoc duties as defined by the Member Services Supervisor.


Job Requirements:

Requirements:
Display high level of confidence when responding to phone inquiries.
Basic knowledge of English for reading, writing and mathematical skills:
generally equivalent to a high school diploma.
Previous experience as a Customer Service Representative required.
Strong verbal communications skills are required.
Proven ability to handle all eligibility related inquiries with ease.
Exhibit advanced job knowledge and quality customer service skills.
Some overtime is required in order to meet scheduled deadlines.

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