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 Call Center Representative - San Juan, PR - SAN JUAN, Puerto Rico, United States

Job information
Posted by: UnitedHealth Group 
Hiring entity type: Insurance 
Work authorization: Existing work authorization required for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Customer service & support
Travel: Minimal 
Accept candidates: from anywhere 
Languages: English - Fluent
Spanish - Fluent
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 857218 / Latpro-3720094 
Date posted: Dec-04-2019
State, Zip: Puerto Rico, Zip not provided


OptumCare is succeeding at helping people live healthier lives by taking a different approach to health care. OptumCare uses a common sense approach, focused on avoiding jargon, finding more efficient ways to operate, and providing great, in-the-moment service. We provide that service by making sure serving our patients and providers is always the first priority. Each department works from the same central idea: “How does this affect the service we provide?” Because of the extreme commitment to service, OptumCare focuses on recruiting passionate employees who will take advantage of being empowered to provide the highest level of service at each and every step.

The role of the Inbound Call Center Local Center is to build trusted relationships with providers in local markets whose mission is to help providers deliver the most effective and compassionate care to each patient they serve. Local Care Delivery’s primary focus is on doing the right things for patients, physicians, and the community. It uses an innovative service model focused on measuring what matters and increasing efficiency and performance while providing the highest level of customer service. This model allows LCD to make a difference each day by delivering highly personal, customized care management to its patients.

Primary Responsibilities:

Accountable for problem resolution of customer issues and to communicate resolution to appropriate parties:

  • Available, as scheduled, to respond to calls from providers regarding claims payments, benefits, eligibility, and certification issues

  • Investigate issues and document steps taken to achieve resolution

  • Manage resolution of issues through contact with the 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 providers regarding status of formal complaints or appeals
  • Meet departmental standards for production and quality
  • Meet departmental standards for schedule adherence
  • Demonstrate a basic knowledge of managed healthcare and claims
  • Adhere to quality improvement initiatives
  • Special projects as required
  • Research complex issues across multiple databases and work with support resources to resolve member issues
  • Provide education and status on previously submitted pre-authorizations or pre-determination requests

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 or higher education
  • 1+ year of previous customer service call center experience 
  • Available to work (40 hours/week) Monday- Saturday. Flexible to work any of our 8 hour shift schedules during our normal business hours of (5:00am to 9:00pm)
  • Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications 
  • Ability to type 30+ WPM 
  • Bilingual in both English and Spanish (English proficiency assessment will be required after application)
Preferred Qualifications:
  • Associate degree or higher education
  • Healthcare experience
  • Knowledge of medical/healthcare insurance/HMO/PPO/Medicare Plans/benefits and medical terminology 
  • Ability to navigate a computer while on the phone 
  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product 
  • Ability to remain focused and productive each day though tasks may be repetitive
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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.

Job Keywords: OptumCare, Inbound Call Center Agents, Puerto Rico


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