Senior Customer Service Representative (8:00am - 4:00pm CST) - Remote in Irving, TX

If you are located within 30 miles of our office location, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 9:30am ? 6:00pm CST. It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 4770 Regent Blvd., Irving, TX 75063.
We offer 2 weeks of paid training. The hours during training will be 8:00am to 4:00pm CST, Monday - Friday. Training will be conducted onsite.

All Telecommuters will be required to adhere to UnitedHealth Group?s Telecommuter Policy.

Primary Responsibilities:

Communicate common problems/questions presented by callers to appropriate Subjects Matter Experts, to drive continuous improvement
Educate callers on available products/services (e.g., features, functionality, options, additional offerings, preventive services, agerelated services)
Educate callers on self service resources available to them, and on their responsibilities with regard to their health care coverage
Refer callers to other resources applicable to their questions/issues, where appropriate (e.g., pharmacists, prior authorizations,billing department)
Review/analyze phone support data/metrics and communicate patterns/trends to internal stakeholders, as needed (e.g.,leadership, Subject Matter Experts, business partners)
Provide training/mentoring to other team members, as needed (e.g., new-hires, refresher training)
Participate in customer site visits, as needed (e.g., to obtain feedback, provide education, clarify support processes, highlight company performance)
Demonstrate knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision)
Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, COBRA, FSA, HRA)
Obtain and apply knowledge of benefit structures/designs for contracted or acquired companies
Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements)
Maintain knowledge of information/process changes due to healthcare reform, referring to applicable company resources (e.g.,dependent age, removal of lifetime limits, free preventive care services, Medical Loss Ratio)
Demonstrate knowledge of established workflows and support processes (e.g., available resources, internal/external business partners, points of contact)
Demonstrate knowledge of relevant internal processes impacting caller issues (e.g., claims processing, auto-adjudication)
Identify inaccurate/inconsistent information found in systems/tools, and communicate to appropriate resources (e.g., IBAAG, SOP,AYS, SPDs, policies/procedures)
Apply knowledge of applicable Service Level Agreements (SLAs) and Performance Guarantees when interacting with callers
Maintain ongoing communications with callers during the resolution process to communicate status updates and other required information
Maintain focus on caller interactions without being distracted by other factors (e.g., system usage, pop-up alerts, VCC data)
Acknowledge and demonstrate empathy/sympathy with callers' life events (e.g., wedding, birth of baby, loss of relative, recent illness)
Manage caller conversations appropriately (e.g., provide a good first impression, command attention and respect, maintain professional tone, demonstrate confidence, de-escalate/defuse callers as needed)
Demonstrate understanding of internal/external factors that may drive caller questions/issues (e.g., recent plan changes, mass mailings, call directing/rerouting, weather emergencies)
Ask appropriate questions and listen actively to identify underlying questions/issues (e.g., root cause analysis)
Gather appropriate data/information and perform initial investigation to determine scope and depth of question/issue
Identify and coordinate internal resources across multiple departments to address client situations, and escalate to appropriate resources as needed
Proactively contact external resources as needed to address caller questions/issues (e.g., providers, labs, brokers)
Utilize appropriate knowledge resources to drive resolution of applicable questions/issues (e.g., websites, CRM tools, Onyx, Siebel, knowledge bases, product manuals, SharePoint)
Identify and communicate steps/solutions to caller questions/issues, using appropriate problem-solving skills and established guidelines, where available (e.g., workarounds, descriptions of relevant processes)
Offer additional options to provide solutions/positive outcomes for callers (e.g., online access to relevant information, additional plan benefits, workarounds for prescription delays)
Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, brokers, pharmacies)
Drive resolution of caller questions/issues on the first call whenever possible (e.g., first-call resolution, one-and-done)
Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution)

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. Required Qualifications:

High School Diploma OR GED
2+ years of claims and / OR provider contracting experience
2+ years of customer response / customer service experience
Ability to work our normal business hours of 9:30am ? 6:00pm CST
Ability to successfully complete the Customer Service training during hours of 8:00am ? 4:00pm CST, Monday ? Friday, and demonstrate proficiency of the material
Must be 18 years of age OR older

Telecommuting Requirements:

Reside within 30 miles of the following office location: 4770 Regent Blvd., Irving, TX 75063
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

Ability to multitask

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone?of every race, gender, sexuality, age, location, and income?deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes ? an enterprise priority reflected in our mission.

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.
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