For Customer Service Provider

Primary Responsibilities:

Answer incoming phone calls from health care providers (i.e. physician offices, clinics) and identify the type of assistance the provider needs (EG. benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits)
Focus on resolving issues on the first call, navigating through complex computer systems to identify the status of the issue and provide appropriate response to caller
Deliver information and answer questions in a positive manner to facilitate strong relationships with providers and their staff
Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends

For Customer Service Member

Primary Responsibilities:

Respond to and resolve customer service inquires and issues by identifying the topic and type of assistance the customer needs such as benefits, eligibility and claims, financial spending accounts and correspondence.
Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being by selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider
Intervene with care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed
Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
Provide education and status on previously submitted pre-authorizations or pre-determination requests
Meet the performance goals established for the position in the areas of: efficiency customer satisfaction, first contact resolution and attendance
Triage inquiries to the appropriate resource
Be physically available from Monday to Friday during normal business hours
Other Duties as assigned.