Requisition number: 2397998
Job category: Customer Services
This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
As a Pharmacy Customer Service Representative or As a Specialty Prior Authorization coordinator, your role will focus on notifying a provider when a prior authorization is required for specialty patients with acute and chronic disease states. In this role you will be preparing prior authorizations for submission, follow up on prior authorization outcome, addressing issues and handling concerns from other corresponding departments.
You've heard this all your life. Trust matters. Being trusted matters a lot. Here at OptumRx we've earned the trust of more than 65 million people who rely on us for the prescription drugs that improve their health and lifestyle. Now, we trust that you can take advantage of some of the best training and tools in the world to help serve our customers and their care providers. This is no small opportunity. This is where you can bring your compassion for others while building your career.
This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 7:00 pm CST. It may be necessary, given the business need, to work occasional overtime.
We offer 3 weeks of paid training. The hours during training will be 9:00 am - 5:30 pm EST, Monday - Friday. Training will be conducted virtually from your home.
Primary Responsibilities:
Handle Initiating PA requests
Validating insurance @types (Medicaid, Medicare, Commercial, etc.)
Accessing multiple Optum resources to check PA status and benefits
Problem-solve with decisiveness and urgency and escalate to operations partners, team leads, management and other stakeholders
Ensure patients and providers are supported by following escalation through to finish
Enters notes / information into pharmacy processing system
Focus on patient care and quality assurance
This role is equally challenging and rewarding. You'll be called on to research complex issues pertaining to member prescription and/or pharmacy benefits across multiple databases which requires fluency in computer navigation and toggling while confidently and compassionately engaging with the caller.
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 work experience
Must be 18 years of age OR older
1+ years of customer service or healthcare industry experience
Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
Ability to attend training from 9:00 am - 5:30 pm EST, Monday - Friday for 3 weeks
Ability to work full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 7:00 pm CST. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications:
1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
Experience in pharmacy or healthcare
Prior Authorization Experience
Knowledge of insurance and third-party billing systems
General knowledge of pharmacy laws, practices and procedures
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.
Soft Skills:
Demonstrated ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
Maintain strict confidentiality and adhere to all privacy and security regulations when handling sensitive information
Ability to manage multiple tasks and set priorities
Ability to establish and execute action plans; able to share your past successes
Ability to be diplomatic when faced with conflict, and always communicate in a professional and courteous manner
Ability to produce quality results with a detail-oriented focus
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $29.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
