Primary Responsibilities:Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondenceHelp 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 providerIntervene with care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when neededAssist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficientOwn problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the memberResearch complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issuesProvide education and status on previously submitted pre-authorizations or pre-determination requestsMeet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
Required Qualifications:1 year of Customer Service experience1 year of experience with Authorizations, Benefits, Claims (doctors office, HMO) Preferred Qualifications:High school diploma or GED OR 10 years of equivalent working experienceHealth care experienceDemonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manners, consistently meeting commitments)Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the memberProficient problem solving approach to quickly assess current state and formulate recommendationsProficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act uponFlexibility to customize approach to meet all types of member communication styles and personalitiesProficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilienceAbility to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as neededAll new hires will be required to successful complete the UnitedHealthcare Operations Customer Service Advocate training classes and demonstrate proficiency of the material AppleCare Medical Management Group. The multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities. Job Keywords: Claims examiner, Medical claims, Health plans, Benefits, customer service, La Palma, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.