Customer Service Associate - Hooksett, NH (10/9/06)

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 16 million people who receive our unique blend of packages and programs. 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:


Receives and responds to calls from Benefit Administrators (BA's) and brokers regarding benefits, policies, procedures and protocols.


Acts as a customer advocate in providing assistance to BAs and Brokers' in order to resolve issues and problems.


Gathers information from other areas to effectively resolve issues.


Coordinates the resolution of inquiries related to authorizations and claims.


Explains the appeals process and protocols necessary to submit an appeal/complaint for review.


Fulfills material requests as necessary.


Facilitates the business exception process within established guidelines.


Facilitates system updates as it pertains to members and groups as needed.


Responsible for facilitating the resolution of enrollment and billing issues and inquiries as appropriate.


Responsible for performing commission inquiries and the facilitation of the Renewal process for small groups, utilizing the established guidelines.


Fulfills established performance levels, metrics and continuously makes recommendations for process improvements.


Reports problems with internal systems, processes or issues generated from BA's and/or Brokers to the Service Team Leader and assigned Account Manager, as appropriate.


Performs Welcome calls and Proactive calls as assigned by Service Teams.


Educates and ensures compliance with all Oxford policies and procedures.


Performs other related projects and duties as assigned.




Job Requirements:

Job Qualifications:


Post High School education/training or an equivalent combination of education and experience.


At least 2 years of previous customer service experience required, preferably processing claims or working in a medical office, sales/service or billing environment.


Previous experience working with Benefit Administration and/or Brokers preferred.


Knowledge of managed care is preferred.


Strong analytical and negotiation skills needed to resolve complex issues.


Strong organizational and time management skills; exhibits reliable and timely follow-up.


Excellent oral and written communication skills and interpersonal skills required.


Previous experience in a system environment required. Strong personal computer skills and ability to learn new applications/software.


Excellent telephone skills including the ability to handle high volume of calls efficiently and courteously.



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