Customer Service Associate - Cypress, CA

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.

At Uniprise, a UnitedHealth Group company, our people and technology meet the benefits needs of employees and families at more than one-fourth of the Fortune 500 companies through customization and innovation. National employers can then best access the full range of products and services offered by UnitedHealth Group companies while enjoying the ease of integrated administration for all employee services. It's a thriving business with an added personal significance…and a rare combination that will allow your career to flourish.



Responsibilities:
Answering 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 calls/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.
Provide excellent customer service to both members and providers by:
Quickly/accurately identify and assess individual provider/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/words.
Establish rapport over the phone 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/negative information in a tactful manner.
Ensure the average call monitoring score over the previous 6 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).
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.
Locate claim reference materials (e.g., Preference, iBAAG).
Process claims requiring standard co-pay resolution.
Identify and resolve claims with eligibility discrepancies.
Identify when to route claims to internal or national queues.
Process claims requiring suspect duplicate resolution.
Perform a same day void, stop payment and/or delete before issue transaction.


Job Requirements:

Requirements:
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.
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.

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