About the Job
Like you, UnitedHealth Group is strong on innovation. And like you, we'll go the distance to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have a chance to make an impact.
- Respond to incoming provider and enrollee calls
- Resolve Customer Service inquiries
- Provide excellent Customer Service to both providers and enrollees
- Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance
- Receive Care Coordination notification cases for non-clinical assessment / intervention and provides appropriate triage
- Process out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate products
- Process notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issues
- Determine benefit coverage issues based on employer group contracts
- Set up / documents / triages cases for (CCR) Clinical Coverage Review
- Ensure all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicable
- Process letters within DOL time frames
- Verify appropriate ICD-10 and CPT coding usage
- Communicate to providers and members benefit determinations within DOL time frames
- Assist with faxes and emails.
- Moderate work experience within own function
- Some work is completed without established procedures
- Basic tasks are completed without review by others
- Supervision / guidance is required for higher-level tasks
- Other duties as assigned by manager and / or director
- High School Diploma / GED
- 1+ years of professional experience in an office / customer service environment
- Previous Healthcare Industry experience
- Knowledge of Medical Terminology
- Previous experience working with Microsoft Word, Microsoft Outlook and Microsoft Excel (ability to create, edit, send and save documents)
- Computer experience including, but not limited to, ability to learn new computer system applications
- Flexibility to work outside standard hours of operations due to changing business needs
- Bachelor's Degree or higher
- Experience working within a Hospital, Physician's Office, or Medical Clinical setting, ICD-10 and CPT codes, Medicare and / or Medicaid Services, call center environment
- Professional experience in a Clerical or Administrative support related role
Join us today and we can provide you with meaningful challenge that can result in a strong sense of impact and fulfillment. It's truly an opportunity to do your life's best work
.SM Careers with UnitedHealthcare.
Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work
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.
Keywords: UHG, Healthcare, UnitedHealth, Clinical, Administrative, Shelton, CT