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The Senior Customer Service Representative - DSNP Retention Team is responsible for handling all incoming Billing and Eligibility phone calls and for serving as the primary customer interface for departmental inquiries. Primary Responsibilities:
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.
Partners with other billing and eligibility department representatives to resolve complex customer service inquiries.
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.
Responds to customer service inquiries in writing as necessary.
Establishes and demonstrates competency in eligibility, billing and receivable systems and associated applications.
Implements customer service strategies and recommends related improvements / enhancements.
Maintains timely, accurate documentation for all appropriate transactions.
Makes corrections and adjustments.
Consistently meets established productivity, schedule adherence, and quality standards.
Proactively seeks to further develop billing and accounts receivable competencies.
Keeps management abreast of all outstanding issues.
Adapts procedures, processes, and techniques to meet the more complex position requirements.
Addresses special (ad - hoc) projects as appropriate.
Seeks involvement in continuous quality improvement initiatives.
Ensures quality customer service for internal and external customers.
Work via an auto - dialer or manually dial members as identified by the Clinical Quality team to remind the member of a gap in their care according to evidence based medicine guidelines and assist the member with barriers they may have to addressing their health needs.
Following a call anatomy, connect with the member to establish a trusting relationship and, utilizing job aids and critical thinking skills, assess the barriers that are prohibiting the member from seeking the proper care, and answer members question about benefits.
If Barrier to Care is provider related the agent will assist the member with finding a new doctor and working with provider's office to set up new appointment.
If Member is identified as having an issue meeting basic needs the agent would help connect the member to community resources.
Responsible for the resolution of escalated member calls that are received by the call center. This could include connecting members with community resources, assisting members to locate a specialist, supporting the intake and resolution of appeals and grievances or resolving other nonstandard member requests.
When appropriate, agents would need to escalate members to social or clinical resources for members requiring more specialized support.
Work offline to resolve member barriers to care requiring more research and follow-up with the member to help remove care barriers.
Work via an auto - dialer, contact newly enrolled members as identified by the Business Intelligence team to welcome them to our health plans. The primary goal of this interaction is to develop a positive relationship and ensure the member has the information and documentation they need to have a positive experience as our member.
Welcome the member to their respective health plan by verifying key information about the member (home address, PCP assignment, etc.) and discussing the benefits available through the plan.
When appropriate, encourage members to appropriately utilize services in an effort to improve the health and well being of all members. This might include education about the importance of using the ER only in true emergencies.
Complete a Health Risk Assessment following the UnitedHealthcare national standard HRA as programmed into CareOne and the HRA database (when necessary).
When possible, correct member information in our databases, including the member's address, PCP assignment.
When possible, order replacement member materials (ID cards, welcome packets) if a member reports that they have not received them or if the member has had a change of address.
When necessary, transfer the member to: member services for advance benefits questions or Care management, if the member has an emergent physical health need or to Optum, if the member has an emergent behavioral health need. If unable to transfer the member, provide the member with the appropriate phone number to contact the resources they need for assistance.
Document member responses and call outcomes in the auto - dialer, Access Database, or CareOne as appropriate.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.