Customer Service Representative (Clinical) - Work From Home

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

$1000 Sign On Bonus For External Candidates

If you are located within a commutable distance to Salt Lake City, UT; Price, UT; Tampa, FL: Albuquerque, NM or Tucson, AZ office locations, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. Training classes start soon - apply today!

Doing your best. That's what we want you to do in this role. Even if you don't have experience, we provide the training and support for you to start your career as a Customer Service Representative (Clinical) . Apply today - training classes start soon!

If you share our all-in approach to people and service, excellence, you're going to be amazed at the things we're doing here at OptumRx. We're one of the largest and most innovative ancillary benefits managers in the US, serving more than 12 million people nationwide. As a member of one of our customer coordination teams, you'll be empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work. SM

As a Customer Service Representative (Clinical) - Work From Home, we'll empower you to deliver resolutions on simple to complex healthcare solutions to our customers by coordinating medical care with case managers, medical equipment and supply vendors, healthcare providers, and hospitals and clinical teams. Every day, you will deliver excellent customer service while working compassionately, efficiently, and effectively to serve our customers. You'll be the direct point of contact for the customers working to move requests to completion, whether they are new requests or rolling requests from the day before. Every phone call gives you that opportunity to improve the lives of our customers and exceed their expectations. That is right; at OptumRX you will be a part of an elite team as you grow and develop at a pace that energizes your career and makes the most of your promise.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:
  • Interacts with customers, vendors, case managers, and healthcare providers through inbound/outbound calls and e-mails to coordinate medical appointment scheduling and ordering/delivery of medical supplies and equipment across multiple databases.
  • Manages the referral process, including intake and prior authorizations.
  • Answers incoming calls from customers and vendors and takes clear and extensive case notes summarizing complex medical and legal documents into detailed case notes.
  • Works with a high degree of autonomy on scheduled responsibilities, while also responding to just in time demands as appropriate.
  • Owns problems through to resolution on behalf of customers through comprehensive and timely follow-up with clients, patients, and vendors, with an understanding of when and where to elevate issues and complex cases.
  • Understands multiple products and services, in order to process medical care for our customers and also shift responsibilities to ensure appropriate coverage as needed.
  • Maintains performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution, and attendance.
  • Maintain patient privacy and confidentiality under requirements of federal and state laws, including HIPPA, and in accordance with company policy.
  • Consistent adherence to the attendance policy and punctuality.

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 higher) or equivalent work experience.
  • 1+ years of customer service experience and/or phone/contact center experience in an office setting
  • Required to live within a commutable distance of the following locations:
    • Salt Lake City, UT
    • Price, UT
    • Tampa, FL
    • Albuquerque, NM
    • Tucson, AZ
  • Based on city/state location must be able to work this shift schedule, including possible weekends if business needs require:
    • Salt Lake City 9 am to 6 pm local time
    • Price, UT 9 am to 6 pm local time
    • Tampa, FL 11 am to 8 pm local time
    • Tucson, AZ 8 am to 5 pm OR 9 am to 6 pm local time
  • Experience with All Windows Systems including Microsoft Outlook (create/send emails and check and use calendars), Microsoft Word (creating and editing documents), and Microsoft Excel (data entry, sorting and filtering)
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.

Telecommuting Requirements:
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:
  • Prior health care or medical experience, particularly in workers compensation, medical supplies and equipment, and/or ancillary services.
  • Background working in a hospital, physician's office setting and/or in the health care industry or with health insurance
  • Knowledge of ICD-10 and HCPC codes
  • Experience with Benefit Verification and/or Prior Authorization

Soft Skills:
  • Ability to remain organized, focused, and productive on highly detailed repetitive tasks.
  • Must be able to quickly and easily shift focus as new priorities arise in a fast-paced, continuously changing environment.
  • Ability to multi-task for extended periods of time, including managing calls while also navigating multiple computer systems.
  • Excellent problem-solving skills, including the ability to independently research issues using multiple information sources while partnering with various other people/departments.
  • Excellent written and verbal communication skills with the ability to listen to customer needs and respond appropriately with compassion and empathy.

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

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

**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.

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.

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