Customer Service Intake Coordinator - Van Nuys, CA

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.



United Behavioral Health, a UnitedHealth Group company, is a leading provider of emotional wellness services. Currently serving over 22 million Americans, our innovative solutions include behavioral health, employee assistance, work/life and pharmacy management services, as well as a unique disability support program. We offer specialized, confidential support to help our members live and work well, and excellent resources and rewards for your career so you can do the same. A healthy business awaits you at UBH.

 

Job Description: 

Respond to, document, investigate and resolve customer calls regarding claims payments, benefits, eligibility and certification. This position also assists providers and members in accessing the UBH MH/SA delivery system. Provides members and providers with basic benefit plan information, prior-authorization requirements, and network referrals.

 

Job Responsibilities:
Accountable for problem resolution of customer issues and 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 within predetermined timeliness-requirements which satisfy or exceed customer and regulatory compliance standards.
Manage resolution of issues through contact with case management, Clinical Claims Review, UBH Eligibility, UBH provider file, or case installation areas.
Maintain accountability for total problem resolution to include claims processing, coordination of adjustments, and communication of resolution as appropriate.
Responsible for meeting or exceeding established quality performance standards, as determined by audit.
Report system problems to Lead/Senior Customer Service Representative and/or Department Supervisor.
Investigate and handle retro-certification activities, as required for resolution of customer issues.
Provide initial telephonic contact and system data entry for members seeking MH/SA services and assist UBH providers who are requesting services on behalf of Health Plan members.
Provide callers with names of participating providers. 
Triages calls from incoming clinical lines to assure that the appropriate services/information are delivered to members and providers in a professional and timely manner. 
 Register patient/update insurance. 
 Issue initial authorization. 
Documents all interactions with customer.
Escalate issues to Lead/Senior Customer Service Rep or Department Supervisor 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.



Job Qualifications:
Reliability: Recognizes the critical nature of reliability in a production oriented environment and behaves accordingly.
Is consistently prepared to begin work on time.
Has a minimal number of unscheduled absences.
Does not abuse attendance policy and sets an example for others through schedule adherence.
Customer Focus: Makes responding to and resolving customer issues a priority.
Treats customers with professionalism, patience and, when appropriate, compassion. 
 Responds appropriately when dealing with difficult customers.
Problem Solving: Faces conflicts and works to resolve them in an appropriate and efficient manner.
Asks questions to pinpoint key issues in complex situations.
Weighs pros and cons of potential solutions.
Applies lessons learned from past experiences to current situation.
Approaches resolution of problems with persistency.
Adaptability: Adapts to changing priorities in the workplace.
Rationally evaluates departmental changes and adapts performance to achieve ultimate performance.
Anticipates concerns and preferences of others and can adapt own behavior when appropriate.
Planning and Organizing: Able to prioritize work and organize day-to-day tasks.
Identifies the most important tasks and plans accordingly.
Breaks activities in to logical parts.
Ensures that steps and tasks are identified before taking action.
Teamwork: Able to work with others in a team environment and understands the value of team achievement.
Shares information with other team members (i.e. best practices).
Able to get along with and work with others.
Helps others by answering questions and supporting their needs.
Industry Knowledge: Basic understanding of claims and managed healthcare.
Can resolve basic claims issues and knows how to investigate or escalate complex issues.
Provides information within the context of a greater understanding of managed care and can explain basic managed care concepts to customers.
Technical Ability: Has the technical skills required to do the job.
Can type quickly and accurately while on the phone.
Can maneuver through multiple software systems to get claims paid.
Learns new systems quickly.
Initiative: Assumes responsibility for getting things done rather than waiting for specific directions.
Takes action without waiting for specific direction to proceed. 
Seeks out work or tasks beyond what is expected of him or her. 
Pursues opportunities and solutions despite repeated obstacles. 
Takes advantage of opportunities to learn, develop new skills etc., out of personal interest. 
1-2 years in managed healthcare and claim resolution strongly preferred. 
1-2 years of customer service experience, preferably in a high-volume call center environment.
PC proficiency in MS Windows and Word required with call center software strongly preferred.
Demonstrated strengths in listening, problem solving, organization and prioritizing. 
AA degree preferred.
Accurate typing skills.
Claims processing and payment experience is desirable.

 

Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V