About this role
Optum is improving the flow of health data and information to create a more connected system. The Senior Customer Service Representative is responsible for providing compassionate and exceptional customer service and issue resolution to consumers, handling inbound phone calls from providers while adhering to policies and procedures.
Responsibilities:
- Assist customers via phone from the Provider Inquiry Line. Incoming calls can be from members and/or Providers questioning claim status, review status, and appeal status
- Provide expertise or general support by reviewing case statuses, researching claims platforms and medical record repositories ultimately analyzing where case is in lifecycle to determine next steps in claim process
- Navigate multiple computer application systems to troubleshoot and resolve inquiries while engaging with the customer and documenting interaction
- Maintains adherence standards of 95% or greater
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Works independently and as part of a team
- Act as a resource for others
- Help internal and external customers by being empathetic, demonstrating patience and good listening skills while providing accurate information
- Manage change in a call center environment, including changes to schedule, business processes and systems/technology
- Assume additional responsibilities as assigned
Requirements:
- High School Diploma/GED
- Must be 18 years OR older
- 2+ years of experience within the healthcare, claims, or insurance industries
- 2+ years of telephonic customer service experience, efficiently handling a high volume of in-bound and/or outbound calls
- Proficiency with Microsoft Word, Microsoft Outlook, and Microsoft Excel
- Ability to work an eight-hour shift between Monday- Friday, 07:00AM - 07:00pm CST. Specific shift will be assigned after training
- Knowledge of medical terminology