San Diego, CA
Customer Service Rep Lead - Healthcare - (San Diego, CA)
Posted over 1 month ago · Full time
The Customer Service Representative Lead is responsible for provider, members, and health plans as serve as the primary interface for departmental inquiries.
- Ensures quality customer service for internal and external customers:
- Responds to incoming customer service requests, both verbal and written.
- Identifies and assesses customers' needs quickly and accurately.
- Solves problems systematically, using sound business judgment.
- Monitors delegated customer service issues to ensure timely and accurate resolution.
- Applies appropriate communication techniques when responding to customers, particularly in stressful situations.
- Places outgoing phone calls to complete follow-up on customer service requests as necessary.
- Ensures quality customer service for internal and external customers.
- Respond to callers with the resolution of issues in a timely manner in accordance with the guidelines set by the department.
- Acts to resolve concerns in accordance for corporate guidelines and standards for all areas of claims, authorizations and IPA functionality.
- Send member letters for termed specialists.
- Work closely with the UM dept. for authorization issues.
- Log issues into the Customer Service Tracking database that require resolution and/or follow-up.
- Functions as liaison between member, physician, health plan, and IPA staff.
- Interprets provider and health plan contracts to ensure accurate responses to calls.
- Addresses special (ad-hoc) projects as appropriate.
- Provides administrative support for back up for the reception area.
- 1 year of customer service experience analyzing and solving customer problems, OR 1 year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
- HMO, healthcare, or medical group experience.
- Proficient in office systems (Windows PC)
- An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
- Available to work 40 hours per week anytime within the operating hours of the site
- Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Ability to organize and multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
- Manage desk individually and a self-starter.
- Ability to remain focused and productive each day though tasks may be repetitive
- Willing to work and contribute in a team environment.
- Ability to execute own assignments under direction of experienced staff.
- Ability to balance and prioritize multiple tasks.
- Flexible to change.
- Responsive to management's requests and suggestion; takes direction.
- Develops goals for self and monitors progress.
- Seeks assistance as appropriate.
- Ability to trouble-shoot problems.
- Completes assignments thoroughly, accurately and on time.
- Demonstrates the potential for development of strong written and verbal communication skills.
- Persists at tasks and maintains high energy level.
- Listens effectively.
- Seeks additional job responsibilities.
- Demonstrated ability in customer service problem resolution and relationship building.
- Has firm understanding of the problems and issues of clients and the business environment.
- Demonstrates customer education and negotiation skills.
- Basic knowledge of managed care industry preferred.
- Demonstrates basic analytical skills.
- Orientation towards team environment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
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.
Job Keywords: Customer Service, CSR, HMO, healthcare, medical group