Managed Care Representative II – Remote

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.  

Managed Care Representatives respond to inquiries from health plan members, providers and various customers while consistently meeting productivity, quality and service standards. Representatives utilize various internal and external software applications to provide Concierge type services related to health plan operations including benefit interpretation for providers, claims resolution, referral inquiries, general plan benefits, Kelsey-Seybold Clinic information, and enrollment eligibility. Managed Care Representatives handle member and provider calls for self-funded, fully insured and Medicare Commercial plans.   

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

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
• 2+ years of experience in a health care environment or insurance environment
• Knowledge of health care and insurance industries and health care delivery systems
• Knowledge of Texas Department of Insurance and ERISA Regulations
• Solid knowledge of HMO Plan Design and Claims Processing
• Demonstrated excellent interpersonal skills to interface with physicians
• Proven solid 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
• Proven analytical skills to evaluate problems and recommend alternative solutions
• Proven Managed Care Representatives must build and maintain productive working relationships with various internal and external customers to solve problems systematically using sound business judgment
• Proven excellent communication and listening skills

Preferred Qualifications:

• Associates or Bachelor’s Degree
• Experience with a call documentation system
• EPIC” Tapestry Experience
• Knowledge of Medical Terminology
• Knowledge of CPT and ICD9 Codes
• Proven ability to Work in a Fast Paced Continuously Changing Environment
• Proven 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.