Clinical Benefits Specialist

At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone.

LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system. LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life’s best work.SM

As a Clinical Benefits Specialist you will primarily work directly with patients to identify their specific needs and/or recommend adjustments to their plan of care. Additionally, the Clinical Benefits Specialist will assist patients in understanding details related to their care, explain their medical benefits/coverage specifics and/or how to access those benefits. The Clinical Benefits Specialist will provide education on the appropriate utilization of services and facilitate preferred provider decisions. The Clinical Benefits Specialist will also be responsible for facilitating clinic patient check-ins and the check-out process, to include face to face consultation regarding exam outcomes, program benefits and needs assessment. The Specialist will serve as the first and last point of contact for clinic patients to address patient needs or questions accordingly while providing a positive patient experience.

This position is full-time, Monday - Friday. Employees are required to work during our normal business hours of 7:00am - 3:30pm EST. It may be necessary, given the business need, to work occasional overtime and weekends. Our office is located at 156 William St, New York, NY 10038.

We offer 1 week of paid training. The hours during training will be 7:00am - 3:30pm EST, Monday - Friday. Training will be conducted onsite.

Primary Responsibilities:

• Ensure proper security measures are adhered to for all clinic patient and staff.
• Operate a multi-line phone system to answer, screen and transfer inbound phone calls.
• Input/update patient demographic data into computer system.
• Identify urgent member situations and escalate to next level when necessary.
• Manage/respond constructively to challenging patient interactions (e.g., address lack of understanding, socioeconomic challenges, frustrated patients, language barriers).
• Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment.
• Provide individualized education on preventative healthcare measures (e.g., immunization, healthcare screening).
• Explain and ensure understanding of details related to patient care (e.g., home health care transition procedures).
• Explain medical benefits/coverage specifics (e.g., procedures/amounts covered, denials of coverage, appeal rights) and/or how to access benefits.
• Educate member on appropriate utilization of services based on need (e.g., PCP vs. ER).
• Facilitate member choice of preferred provider.
• Coordinate/confirm scheduling of doctor visits/services with patients, verify referral approval.
• Use desk top computer applications (e.g., MedNet, Excel, Word, Outlook, Office Communicator) to summarize information (e.g., reports) or communicate member information to others.
• Document information (e.g., assessment information, member interactions, referrals, follow up plans) in relevant computer systems.
• Collect, scan and upload medical records into appropriate data systems.
• Print exam documents and review outcomes with the member.
• Navigate multiple applications at once to obtain and/or document member information.
• Learn updates and changes to computer systems/applications and apply to navigate applications effectively.
• Troubleshoot computer/database issues, report IT issues for resolution.

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 equivalent work experience.
• Must be 18 years of age OR older.
• 3+ years of experience working in a health care role.
• 1+ years of experience working with medical insurance.
• Understanding of Federal privacy regulations (e.g., HIPAA).
• Understanding of policies/procedures that apply to patient care.
• Knowledge of safety guidelines/practices (e.g., OSHA).
• Knowledge of basic medical terminology and human anatomy to document patient information using standard language/medical terminology.
• Ability to work during our normal business hours of 7:00am - 3:30pm EST. It may be necessary, given the business need, to work occasional overtime and weekends.
• Ability to work onsite at 156 William St, New York, NY 10038.

Preferred Qualifications:

• Bilingual fluency in English/Mandarin.
• Bilingual fluency in English/Cantonese.
• Understanding of managed care practices/contract provisions to evaluate appropriateness of services (e.g., contracted providers, financial implications, relevant regulations).

Soft Skills:

• Excellent verbal communication, telephone etiquette and interpersonal skills.
• Strong customer service orientation.
• Ability to work independently.
• Ability to multi-task; think and act quickly in an emergency.

New York Residents Only: The hourly range for this is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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