Call Center Representative Clinical Administrative Coordinator Senior - Aarp - National Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

At UnitedHealthcare , we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing your life’s best work. SM

Positions in this family include those responsible for functions in areas such as health services, clinical services, and delivery of clinical care. Positions in this function includes those responsible for initial triage of members, administrative intake of members or managing the admission/discharge information post-notification, working with hospitals and the clinical team. Includes managing incoming calls, managing requests for services from providers/members, providing information on available network services and transferring members as appropriate to clinical staff. Manages the referrals process, processes incoming and outgoing referrals, and prior authorizations. This function includes intake, notification, and census roles. *Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement.

This position is full-time. Employees are required to work our normal business hours of 9:00am – 5:30pm CST. It may be necessary, given the business need, to work occasional overtime or weekends.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Works independently.
• Extract and review fax requests for medical or clinical services
• Sometimes acts as a technical resource to others in own function.
• Reference automated job aid tools via computer to research relevant rules, regulations, or procedures
• Receive calls requesting medical/behavioral/clinical services or benefits information (e.g., from providers or members)
• Document call history information into relevant computer system
• Enter medical request data into relevant computer system
• Reference automated job aid tools via the computer to identify appropriate procedures when needed CLA_Research Information to Respond to Medical/Behavioral/Clinical Services or Benefits
• Check procedure codes against notification requirements and benefit coverage to determine next steps
• Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests CLA_Process Medical/Behavioral/Clinical Services or Benefits Requests
• Follow protocols to task requests appropriately
• Provide information regarding appointments and medical services to facilities staff to assist members
• Schedule appointments for members based on request
• Plans, prioritizes, organizes, and completes work to meet established objectives.
• Serve as primary point of contact for providers or members regarding medical/behavioral/clinical services or benefits
• Determine whether authorizations are required for requested medical services
• Learn computer system and process changes and updates and incorporate into daily work
• Works with team to solve complex problems.
• Utilize phone system to respond to and transfer calls to appropriate individuals
• Work is frequently completed without established procedures.
• Demonstrates great depth of knowledge/skills in own function.
• May coordinate others' activities.
• Review and advise member/provider of status of a request (e.g., notification, authorization)
• May act as a resource for others.
• Provide/explain authorization information to members/providers
• Ask callers standard questions to understand requests, gather necessary information, and assess urgency
• Review and interpret call history documentation (e.g., case notes)
• Communicate with clinical team to ensure provider receives a response when necessary
• Request medical review via relevant computer system as needed
• May coordinate work of other team members.
• Contact internal resources if necessary to clarify information
• Extensive work experience within own function.
• Provide/explain benefit information to members/providers
• Take calls and questions from members and/or providers regarding case status
• Receive electronic referral form requests for medical/behavioral/clinical services
• Proactively identifies solutions to non-standard requests. - Solves moderately complex problems on own.
• Follow standard procedures to complete requests
• Access claims information
• Access electronic member files using policy or id number -Determine member eligibility
• Extensive work experience within own function. Applies knowledge/skills to a range of moderately complex activities.
• Navigate between computer screens and platforms to research information (e.g., medical, clinical, or benefits information)

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:

• 1+ years of call center experience
• Ability to work full-time. Employees are required to work our normal business hours of 9:00am – 5:30pm CST. It may be necessary, given the business need, to work occasional overtime or weekends.
• High School Diploma / GED (or higher)

Preferred Qualifications:

• Health Insurance Experience

Telecommuting Requirements:

• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy

Careers with UnitedHealthcare. Work with a Fortune 5 organization that’s serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

California, Colorado, Connecticut, Nevada, Washington, or New York, Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $18.80 - $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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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