Complex Customer Care Representative

• Documents all member interactions in a concise manner that is compliant with documentation requirements for Model of Care NCQA and Center for Medicare and Medicaid Services (CMS) regulations.
• Receives and responds to incoming Care Coordination inquiries from all communication venues: e.g. phone queue CM/UM electronic platform portal department e-mail box or RightFax.
• Coordinates and assists in monitoring of documentation Care Management queues for Disease Management Transitions of Care Complex Care and Social Work referrals.
• CTA processes CM requests via all communication venues; as well as administrative preparation for clinical staff.
• Conducts in-bound and out-bound calls for program requirements including but not limited to: member scheduling surveys/screenings census management and distribution of materials to appropriate clinical personnel or members.
• Performs daily preparation of INPT and Post-Acute Census for use in CM referrals and informs Care Management Manager of outstanding cases to ensure adherence to NCQA regulations.
• Completes timely data entry of in-bound and/or out-bound call member contact information into software applications.
• Provides clerical and/or administrative support to clinical staff and managers for special projects and reporting needs.
• Provides excellent customer service by serving as a resource to all internal and external customers.
• Attends required meetings and participated in ad hoc committees as needed.
• Maintains knowledge of all health plan benefits network NCQA regulations health plan policies.
• Identifies opportunities for process improvement in all aspects of member care.
• Must always maintain strict confidentiality.
• Must adhere to all department/organizational policies and procedures.
• Performs all other related duties as assigned

• High School Diploma / GED OR equivalent years of work experience
• Must be 18 years OR older
• Certified Medical Assistant Training
• 2+ years of administrative support experience working in a medical care setting as a medical assistant (within the last year)
• Medical terminology knowledge base
• Advanced knowledge of Microsoft Office products including Excel Word and Outlook
• Ability to toggle between multiple IT systems and platforms
• Ability to work full time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 4:30 pm EST.

• Active Medical Assistant Certification
• 2+ years of experience in a physician's clinic or hospital
• Ability to prioritize plan and handle multiple tasks/demands simultaneously
• Ability to work independently with some supervision and direction from manager
• Ability to maintain and demonstrate a high degree of professionalism to include both personal conduct and appearance at all times
• Ability to possess and demonstrate excellent organizational skills customer service skills to include verbal and written communication

• Reside within commutable distance to the office at 3 FARM GLEN Blvd Farmington CT.
• 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.

• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving
• Able to prioritize plan and handle multiple tasks/demands simultaneously

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery

What We Do

Optum part of the UnitedHealth Group family of businesses 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 to start Caring. Connecting. Growing together. At Optum we support your well-being with an understanding team extensive benefits and rewarding opportunities. By joining us you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.

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