Member Services Representative II

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

The Member Service Representatives II-KSPA provide concierge service to members of the health plan which include providing a high level of service to callers and making outreach calls to members to provide information regarding health plan policies, obtain responses to various required surveys and promote member retention and growth initiatives.  

If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. 

Primary Responsibilities:

• Resolve inquiries from health plan members, providers, and various customers while consistently exceeding productivity, quality and service standards
• Demonstrates a proven ability to quickly learn and put into practice software applications to respond to administrative issues related to health plan operations including claims resolution, premium billing, medical benefit interpretation, organization and coverage determinations, referral inquiries, Prescription Drug inquiries and enrollment/disenrollment activities  
• Handles member and provider calls for our Medicare Advantage plan and have demonstrated ability to interpret Medicare Policy and Procedures including but not limited to late enrollment penalty, low income subsidy, enrollment/disenrollment guidance, Medicare beneficiary protections and Medicare coverage rules
• Supports KelseyCare Advantage chat conversations and make outbound calls to assist with scheduling member appointments and to determine disenrollment reasons

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 GED from an accredited program
• 5+ years of experience in a health care or health plan insurance environment
• Demonstrated experience using analytical skills to evaluate problems and recommend alternative solutions
• Demonstrated experience using excellent communication and telephone etiquette, problem-solving and active listening skills 
• Knowledge of health care and insurance and the ability to Interpret/apply Medicare prescription drug benefits, medical benefit interpretation, CMS regulations, Texas Department of Insurance Regulations and ERISA
• Solid knowledge of HMOPOS and TPA Plan Design and Claims Processing
• Demonstrated excellent interpersonal skills to interface with physicians and members of the health plan. 
• Demonstrated ability to actively listen to customers, probe for clarification, and provide consultative guidance based upon customers inquiries
• Proven ability to use a variety of software applications and on-line resources
• Demonstrated excellent written communication skills

Preferred Qualifications:

• Experience with a call documentation system
• EPIC Tapestry Experience
• Knowledge of medical terminology
• Knowledge of CPT and ICD9 Codes
• Demonstrated ability to work in a fast paced continuously changing environment
• Demonstrated ability to understand complex oral and written directions and technical information
• Fluency in Spanish

*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 $17.74 to $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.