Customer Service Representative

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 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 between 7:00am – 9:00pm CST, Saturday 8:00am – 5:00pm CST.

Open most holidays from 8:00am-5:00pm CST. It may be necessary, given the business need, to work occasional overtime. Shift bids (schedule reassignments) occur 1-2 times per year, depending on business needs. During the shift bid process, your schedule will change. You will have the option to rank your preferred schedules, and the awarded schedule will be determined based on individual performance and metric ranking.

We offer 3 weeks of paid training. The hours during training will be 8:00am to 4:30pm CST, Monday – Friday. Training will be conducted virtually from your home.

• Answer 50-70 incoming phone calls per day from members and identify the type of assistance needed. Will be taking calls to verify benefit coverage, prior authorization approval, checking on status of prior authorization and educating members on appeal option.
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
• Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues.
• As a member of our Prior Authorization (Prior Auth) team, the Customer Service Representatives (CSRs) are entrusted with the responsibility of interfacing directly with members to support and guide them through the intricacies of the prior authorization process. The training class for the Customer Service Reps will encompass the following key duties:
• Educate Members on Status Updates: CSRs will be thoroughly trained to provide accurate and timely updates to members regarding the status of their prior authorization requests. They must ensure that members are kept informed throughout every step of the process.
• Clarify Decision Outcomes:
  It is crucial for CSRs to communicate the decisions regarding prior auth requests clearly and compassionately. They must be prepared to explain the rationale behind the decisions and what those decisions entail for the members.
• Insight on Appeals Information:
  In instances where a prior auth request is denied, CSRs will provide members with comprehensive information on the appeals process. This includes guiding them on how to initiate an appeal, the documentation required, and the timeline for the appeals process.
• Provide Alternatives and Cost-Saving Options:
  When appropriate, CSRs will suggest alternative therapies or medications that may be more cost-effective or better suited to the member’s needs, always in consultation with medical guidelines and coverage policies.
• You’ll be handling difficult types of calls and cases dealing with personal and confidential health care issues as it relates to Prior Authorization.
• In this position, you may receive calls from frustrated members. It is important to remember that they are upset about the situation they are in and not necessarily with you directly. You will need to be able to move on to the next call without letting the previous call upset you. To do so you will need (patience, positivity and ability to maintain calm).
• Patience and the ability to deal with frustration and maintain positive attitude even in the face of an upset caller.

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