UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.
In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.
Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am - 5:00pm CST). It may be necessary, given the business need, to work occasional overtime. Our office is located at 115 W WAUSAU AVE. Wausau, WI.
This will be on the job training and the hours during training will be 7:00am - 5:00pm CST, Monday – Friday.
Primary Responsibilities:
- Provide an exceptional customer service experience when responding to and resolving 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 correspondence
- Updating information on member files within CPS system (claims processing system, OnBase)
- Research complex issues (such as Medical, Dental, Flex Spending, etc.) across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
- Own issue through to resolution on behalf of the member/provider requests that are received
- Apply creative solutions and effective problem-solving techniques to address members/provider needs
- Address complex issues with an awareness of when to refer complicated situations to various departments or leadership for further assistance
- Searching system for member information variety of systems (example: Explanation of benefits, reviewing call track information, appeals invoicing, check/payment tracking)
- Process medical record payments
- Manually entering in various types of claims (medical, dental, vision)
- Creating various correspondence to be mailed
- Running various reports systems
- Cross train and work in all processes when needed
- Other duties as assigned
- Repetitive movements including siting, stand, kneel, and reaching
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.
Required Qualifications:
- High School Diploma / GED (or higher) OR 10+ years of equivalent work experience
- Must be 18 years of age OR older
- 1+ years of experience working in an office or professional setting
- Ability to navigate a PC to open multiple applications, send emails, conduct data entry, and learn new and complex computer system applications, as well as using dual monitors
- Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
- Proficiency in Microsoft Office Suite - Word (ability to create, edit, copy, send and save documents)
- Proficiency in Microsoft Office Suite - Excel (ability to create, edit, copy, send and save spreadsheets)
- Proficiency in Microsoft Office Suite - Outlook (ability to create, edit, copy, send correspondence)
- Familiarity with medical terminology, health plan documents, or benefit plan design
- Translate healthcare-related terms or terminology processes into simple, step-by-step instructions which members can understand
Soft Skills:
- Ability to remain focused and productive each day though tasks may be repetitive
- Ability to multi-task as well as the ability to understand multiple products and multiple levels of benefits within each product
- Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrate personal resilience
- Proficient problem-solving approach to quickly assess current state and formulate recommendations
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a respectful, timely manner, consistently meeting commitments)
- Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member or customer
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
Physical Requirements and Work Environment:
- Service center environment with moderate noise level due to representatives talking, computers, printers, floor activity
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
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