Provider Customer Service Representative - Remote in Nebraska, Sioux City, IA, Council Bluffs, IA an

$1500 Sign On Bonus For External Candidates

If you are located within the state of Nebraska, Sioux City, IA, Council Bluffs, IA and Carter Lake, IA, you will have the flexibility to telecommute (work from home) as you take on some tough challenges.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. SM

Provider Service contact center advocates support the millions of providers who care for our 50 million members. The responsibilities completed by provider service advocates reduces downstream follow-up and research members. This, in turn, reduces downstream workloads for other service organizations supporting members across the enterprise.

PSO contact center advocates serve healthcare professionals who are fluent in healthcare terminology, often with many years of experience across multiple payers. These healthcare professionals expect to receive timely, confident, and thorough responses to questions that span the full continuum of care delivered to a member, including but not limited to:

• Benefits and eligibility
• Billing and payments
• Clinical authorizations
• Explanation of benefits
• Behavioral health.

Meeting this expectation requires PSO contact center advocates to possess a deep knowledge of UnitedHealthcare's products, procedures, and billing practices to ensure that the provider receives an excellent experience during their encounter. New contact center advocates complete extensive new-hire training over a 12-13 week period and ongoing education to ensure their thorough preparedness to meet and exceed provider expectations for each call encounter.

Role Overview

• Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues
• Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices)
• Seek to understand and identify the needs of the provider, answering questions and resolving issues (e.g. benefits and eligibility, billing and payments, clinical authorizations, explanation of benefits, behavioral health)
• Research and dissect complex prior authorization and claim issues and take appropriate steps to resolve identified issues to avoid repeat calls, escalations, and provider dissatisfaction
• Collaborate effectively with multiple internal partners to ensure issues are resolved and thoroughly communicated to providers in a timely manner
• Strong multitasking to effectively and efficiently navigate more than 30 systems to extract necessary information to resolve and avoid issues across multiple lines of business (C&S, M&R, E&I) provider types, and call types
• Influence providers to utilize self-service digital tools assisting with navigation questions and selling the benefits of the tool including aiding in faster resolution

Provider Service Operations - A day in the life: Service Operations - A day in the life/1_b5lltr5d

This position is full-time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6am - 6pm. It may be necessary, given the business need, to work occasional overtime.

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

Primary Responsibilities:

Phone Support and Provider Issue Resolution

• Quickly and appropriately triage contacts from healthcare professionals (i.e. physician offices, clinics, billing offices)
• Seek to understand and identify the needs of the provider, answering questions and resolving issues (e.g. benefits and eligibility, billing and payments, clinical authorizations, explanation of benefits, behavioral health)
• Research and dissect complex prior authorization and claim issues and take appropriate steps to resolve identified issues to avoid repeat calls, escalations, and provider dissatisfaction
• 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
• Collaborate effectively with multiple internal partners to ensure issues are resolved and thoroughly communicated to providers in a timely manner
• Meet performance goals established for the position optimizing provider satisfaction, first call resolution, and attendance
• Learning new skills will be required over time in this role as the function evolves and business needs change

Provider Experience and Service Excellence

• Serves as the advocate for providers by demonstrating accountability and ownership to resolve issues
• Influence providers to utilize self-service digital tools assisting with navigation questions and selling the benefits of the tool including aiding in faster resolution
• Meet performance goals established for the position optimizing provider satisfaction, first call resolution, and attendance
• Maintain ongoing communications with callers during the resolution process to communicate status updates and other required information
• Maintain focus on provider interactions without being distracted by other factors
• Identify inaccurate/inconsistent information found in systems/tools, and communicate to appropriate resources

Business Acumen and Industry Knowledge

• Possess a deep knowledge of UnitedHealthcare's products, procedures, and billing practices to ensure that the provider receives an excellent experience during their encounter
• Demonstrate knowledge of applicable health care terminology
• Maintain knowledge of information/process changes due to healthcare industry changes (e.g., regulatory/governmental reforms, innovations, process improvements)
• Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements)

Continuous Learning

• Learn new skills as the function evolves and business needs change
• Demonstrate knowledge of established workflows and support processes
• 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)

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 / GED (or higher) with 1+ years customer service experience
• Proficient with personal computer applications (e.g., Microsoft Excel, Microsoft Word)

Preferred Qualifications:

• Familiar with medical and healthcare terminology
• Proficient with personal computer applications (e.g., Microsoft PowerPoint)

Telecommuting Requirements:

• Reside within the state of Nebraska
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• 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 collaborate in a team building environment
• Effective verbal and written communication skills; Strong listening skills
• Strong problem solving and investigative skills

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

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