Great jobs start with great training and our next class is starting soon. Apply today.
OptumCare is succeeding at helping people live healthier lives by taking a different approach to health care. OptumCare uses a common sense approach, focused on avoiding jargon, finding more efficient ways to operate, and providing great, in-the-moment service. We provide that service by making sure serving our patients and providers is always the first priority. Each department works from the same central idea: “How does this affect the service we provide?” Because of the extreme commitment to service, OptumCare focuses on recruiting passionate employees who will take advantage of being empowered to provide the highest level of service at each and every step.
This position is full-time (40 hours/week) Monday- Saturday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (8:00am - 8:00pm Monday-Friday and 9:00am - 1:00pm Saturday). It may be necessary, given the business need, to work occasional overtime. Our office is located at One Harmon Drive, Secaucus, NJ.
The role of the Services Advocate is to build trusted relationships with members across their health care lifecycle. This is done by assisting members with their customer service needs, educating members about management of their health and well-being, helping members to maximize health plan benefits and personal health care dollars and owning customer service inquiries through to resolution. Another purpose of this position is to support the mission, vision and values of the organization and department through quality, service, innovation, integrity, teamwork and dignity/respect. The employee specifically contributes to organizational/departmental success through:
- Member satisfaction with OptumHealth Collaborative Care, guest/member retention, and guest/member contacts/information gathering
- Policy/process identification and improvement
- Ongoing quality improvement for customer care interactions
- Providing Excellent Customer Care to our guests/members
- Accountable for problem resolution of customer issues and to communicate resolution to appropriate parties.
- Available, as scheduled, to respond to calls from customers regarding claims payments, benefits, eligibility, and certification issues.
- Investigate issues and document steps taken to achieve resolution.
- Coordinates the provision of multiple services to patients performing a full range of administrative support services for clinic/site including registration and scheduling of patients for medical procedures, tests, associated ancillary services and other related duties. Responsible for providing the highest level of patient/customer satisfaction. Respond to customers regarding status of formal complaints or appeals.
- Verifies, re-verifies and authorizes patient insurance coverage and eligibility utilizing computer based patient registration/scheduling system. Verifies and updates demographic, insurance, and other patient information. Confirms, collects, and posts patient co-payments and other outstanding balances.
- Participates on a variety of committees that relate to appointment schedules as the expert in the creation and maintenance of provider schedules.
- Provides patient education regarding managed care plans and referral process. Assists patients with referral questions, concerns, etc. Counsels and advises patients of available options.
- Enters new referrals or ensures that existing referral numbers are linked in the system to ensure managed care requirements are met.
- Reconciles all referral discrepancies. Calls patients, employers, insurance companies, etc., as required for further verification of insurance, demographic data, medical service authorization, etc.
- Works collaboratively with primary care practices, patients and specialty practices to process outgoing referrals prior to scheduled visits. Follows up with practices that do not issue a referral or obtain referral on a timely basis.
- Interfaces with staff, providers and patients regarding denied referrals. Documents information and assists with alternate plan of care, if needed.
- Follows up on a variety of reports, such as indisposed referral report, etc., resolving discrepancies as required.
- Escalate issues to Senior Customer Service Reps when appropriate.
- Meet departmental standards for production and quality.
- Meet departmental standards for schedule adherence.
- Participate in training and self-development opportunities when appropriate.
- Demonstrate a cooperative, positive attitude in the workplace.
- Demonstrate a basic knowledge of managed healthcare and claims.
- Perform all other duties as deemed appropriate to provide customer service
- Adhere to quality improvement initiatives.
- Special projects as required
- Connect members with internal specialists for assistance when needed
- Partner with others to resolve escalated issues
- Provide education and status on previously submitted pre-authorizations or pre-determination requests.
- Mentor new hires and existing staff in the efficient use of call handling best practices designed to ensure accurate and consistent call responses
- Launch outbound calls as appropriate
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.
High school diploma/GED (or higher)
1+ years of Customer service experience
Ability to type 30+ WPM
Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
Available to work 40 hours per week anytime within the operating hours of the site, which may include weekends and holidays
There are several steps in our hiring process - it’s a thorough process because we want to ensure the best job and culture fit for you and for us. In today’s ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you’ll receive an email with next steps. This may include a link for an on-line pre-screening test(s) (or what we call an assessment) that we ask you to complete as part of our selection process. You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Keywords: customer service representative, customer service, CSR, UnitedHealth Group, call center, UnitedHealthcare, Optum, health care, office, phone support, training class, SME, Senior, SR