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

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.

Positions in this function are also responsible for keeping their existing customers while taking on the additional responsibility of becoming a member of the Mentoring Team and mentoring and supporting new customer specialists.

Positions in this function are also responsible for first-level response and resolution of escalated issues with external and internal customers.

Responsible for the overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership.

This position will continue to report their current Customer Specialist Manager

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 8 : 00am - 8 : 00pm EST.

It may be necessary, given the business need, to work occasional overtime.

This will be on the job training and the hours during training will be 8 : 00am - 8 : 00pm EST, Monday Friday. Training will be conducted virtually from your home.

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

Primary Responsibilities :

• Works independently to manage own tasks and applies knowledge / skills to a range of complex activities.
• Proactively identifies non - standard requests and potential problems; investigates and solutions using defined processes, expertise and judgement.
• Resolution is determined by use of knowledge, research, and internal contacts.
• Identify potential claim and / or customer service issues during implementation and create a plan to ensure risk is minimized.
• Consults with key business partners outside of team to ensure benefit intent is understood based on source documents and output matches (coding, SAE, PNO, network services, integration support)
• Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers.
• Identify and resolve operational problems using defined processes, expertise, and judgment.
• Investigate claim and / or customer service issues as identified and communicate resolution to customers.
• Responsible for maintaining customer’s medical plans installation documents.
• Responsible for testing customer benefit changes in CPS
• Create and update HPDB’s.
• Identify the need for and providing specific and remedial training to processors or CFR’s.
• Large claim file reviews
• Monitor large dollar claims - for stop loss.
• Respond to SBA and external vendor audits.
• May act as a resource for others.
• May coordinate other activities.
• Responsible for coaching new Customer Specialists

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 equivalent experience.
• Must be at least 18 years of age or older.
• 3 years of Customer Service experience with analyzing and solving customer problems.
• Experience with GEHA members
• Ability to work 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 8 : 00am - 8 : 00pm EST.

It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications :

• Experience with UMR CPS (Must be within UMR business line)
• Experience with working within cross functioning departments of UMR
• Experience with CPS medical installation documents and implementation checklists
• Current / previous experience as a Service Account Manager Associate within UMR
• Experience with using Microsoft Word (creating and editing documents), Microsoft Excel (creating basic formulas, creating, and managing pivot tables), and Microsoft Outlook (creating and sending emails)

Telecommuting Requirements :

• 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.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only : The hourly range for this is $23.

22 - $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k 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.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected.

Job posting may come down early due to volume of applicants.

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.

Last updated : 2024-06-12