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Call Center Representative

1 month ago

PR United States Optum Full time
Job Description

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. 

 

As an Associate Pharmacy Care Coordinator you will effectively support the successful implementation and execution of all pharmacy programs and processes. You will provide support to the pharmacy staff to ensure applicable program processes and operational responsibilities are met. The Associate Pharmacy Care Coordinator will be responsible for determining eligibility of members applying for the Medical Assistance Program (MAP). This position will also provide support in troubleshooting any member issues identified by the pharmacy staff during member outreach calls.

 

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of 10am-7pm/11am-8pm AST. It may be necessary, given the business need, to work occasional overtime or weekends.  Our office is located in the Montehiedra area in San Juan.   

 

Primary Responsibilities:

  • Receives and responds to escalated pharmacy inquiries from all communication venues: e.g. phone queue, portal, claim queue, department e-mail box or fax
  • Coordinates and assists initial screening of MAP enrollment requests via all communication venues; as well as administrative preparation for clinical staff
  • Conducts in-bound and out-bound calls for program requirements including, but not limited to: patient scheduling, surveys/screenings, reminder calls, census management and distribution of materials to appropriate clinical personnel or patients
  • Initiates the process of granting, modifying, denying, or terminating assistance, or referring applicants to other agencies for assistance
  • Collects and maintains eligibility information in an appropriate and confidential manner
  • Interviews applicants by phone for program requirements
  • Enters all assigned applications within a specified time frame in order to ensure eligibility deadlines are met accordingly
  • Exhibits excellent phone and communication skills while providing complete and accurate information to customers
  • Requests additional or supplemental information via correspondence in order to complete applications
  • Adheres to assigned schedule and quality metrics
  • Uses a multi-lined telephonic system to answer calls regarding eligibility requirements
  • Maintains abreast of program qualifications in order to troubleshoot problems that may arise during the eligibility process
  • Completes calls/assignments and ensures census management, productivity weekly and monthly standards are met
  • Provides clerical and/or administrative support to clinical staff and managers for special studies, projects and reports
  • Provides excellent customer service by serving as a resource to all internal and external customers
  • Attends required meetings and participates in special committees as needed
  • Performs other duties as assigned

 

*** ENGLISH PROFICIENT ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***

 

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:

  • 1+ years of customer service, call center or administrative support experience
  • Proven medical terminology knowledge or familiarity
  • Proven knowledge of Microsoft Office products, including Word and Outlook
  • Professional proficiency in both English and Spanish. Please note that an English proficiency assessment will be required for his position
  • Ability to work any of our 8 hour shift schedules during our normal business hours of 10am-7pm/11am-8pm AST. It may be necessary, given the business need, to work occasional overtime or weekends

 

Preferred Qualifications:

  • Certified Medical Assistant training or certification
  • Experience in a medical setting, such as physician’s office, clinic or hospital
  • Pharmacy Technician experience or training
  • Proven familiarity with Medicare Advantage and/or CMS STARS program
  • Proven ability to work independently, with some supervision and direction from manager

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.