Position Summary:
Coordinates, supervises and is accountable for the daily activities of business support. Owns output at task level. Work is generally limited to own function. Sets priorities for the team to ensure task completion. Coordinates work activities with other staff. Develops plans to meet short-term objectives. Identifies and resolves operational problems using defined processes, expertise and judgment. Decisions are guided by policies, procedures and business plan. Product, service or process decisions are most likely to impact individual employees and/or customers.
Primary 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.
- Manage resolution of issues through contact with Optum claims department, case management, and external payers ultimately achieving a positive outcome.
- Investigate and handle retro-certification activities, as required for resolution of customer issues.
- Respond to customers regarding status of formal complaints or appeals.
- Escalate issues to upper management 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.
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