Operations Service Manager (OSM) - Clearwater, FL at UnitedHealth Group

UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.

In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.

Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.

This role is equally challenging and rewarding. Within a high-volume environment, you’ll need to model and act as an ambassador for the company while solving complex health care inquires The Customer Specialist (Service Account Manager Associate) acts as a customer advocate to resolve escalated and complex issues.

This position is full time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime. Our office is in Pinellas County located at 400 S Fort Harrison Ave., Clearwater, FL 33756

Primary Responsibilities:

• Works independently to manage own tasks and applies knowledge/skills to a range of complex activities
• Demonstrates great depth of knowledge/skills in own function and increased knowledge/skills in other functions such as coding, networks, integration, HRA, HCR regulations, etc.
• Proactively identifies non-standard requests and potential problems; investigates and solutions using defined processes, expertise, and judgement.  Resolution is determined by use of knowledge, research, and internal contacts.
• Identify potential claim and / or customer service issues during implementation and create a plan to ensure risk is minimized
• Consults with key business partners outside of team to ensure benefit intent is understood based on source documents and output matches. (Coding, SAE, PNO, network services, integration support).
• Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers
• Identify and resolve operational problems using defined processes, expertise, and judgment
• Investigate claim and / or customer service issues as identified and communicate resolution to customers
• Responsible for maintaining customer’s medical plans installation documents
• Responsible for testing customer benefit changes in CPS
• Create and update HPDB’s
• Identify the need for and providing specific and remedial training to processors or CFR’s
• Large claim file reviews
• Monitor large dollar claims - for stop loss
• Respond to SBA and external vendor audits
• May act as a resource for others
• May coordinate other activities

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
• Must be 18 years of age OR older
• 2+ years of Customer Service experience analyzing and solving customer's problems
• Basic proficiency with Windows computer applications, which includes the ability to learn new and complex computer system applications
• Must reside within commutable distance to Pinellas County located at 400 S Fort Harrison Ave., Clearwater, FL 33756
• Ability to work full time, Monday - Friday. Employees are required to have flexibility to work our normal business hours of 8:00am - 5:00pm CST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Current or previous employment at Cigna

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.

#RPO #RED

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