Position Description: 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. There may be easier administrative jobs out there, but few offer the satisfaction of truly helping people manage their personal health and well-being. UnitedHealthcare, part of the UnitedHealth Group family of businesses, is serving employers and individuals, states and communities, military families and veterans wherever 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. Our customer service teams have a serious responsibility to make every contact informative, productive, positive and memorable. If you're the kind of person who wants to bring your contribution to a new level every day, find out more. Primary Responsibilities:Respond to incoming provider and enrollee callsResolve Customer Service inquiries Provide excellent Customer Service to both providers and enrolleesConstantly meet established productivity, schedule adherence, and quality standards while maintaining good attendanceReceives Care Coordination notification cases for non-clinical assessment / intervention and provides appropriate triageProcesses out of network requests for consideration of in network level of benefits for physician specialty referrals for appropriate productsProcesses notification requirements for outpatient procedures, home health, DME, transition of care, and network gap issuesDetermines benefit coverage issues based on employer group contractsSets up / documents / triages cases for (CCR) Clinical Coverage ReviewEnsures all potential member needs are identified and forwarded to the appropriate Care Coordinator for risk validation when applicableProcesses letters within DOL time framesVerifies appropriate ICD-10 and CPT coding usageCommunicates to providers and members benefit determinations within DOL time framesAssist with faxes and emails.Moderate work experience within own functionSome work is completed without established proceduresBasic tasks are completed without review by othersSupervision / guidance is required for higher-level tasksOther duties as assigned by manager and / or director
Required Qualifications:High School Diploma / GED1+ years of professional experience in an office / customer service environmentPrevious Healthcare Industry experienceKnowledge of Medical TerminologyPrevious 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 applicationsFlexibility to work outside standard hours of operations due to changing business needsPreferred Qualifications:Bachelor's Degree or higherExperience working within a Hospital, Physician's Office, or Medical Clinical setting, ICD-10 and CPT codes, Medicare and / or Medicaid Services, call center environmentProfessional experience in a Clerical or Administrative support related roleJoin us today. It's a chance to help improve life for millions of people and a role that can lead to your life's best work.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
Internal Number: 751076
About UnitedHealth Group
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.