Coordinates and handles outgoing nonstandard and more complicated eligibility files for ID cards, pharmacy vendors, 270/271 process, and other vendors Coordinates calls/meetings with external and internal customers (workgroups and multiple departments) including vendors Lead IT coding projects and tasks for the Enrollment System and Electronic Eligibility processes. Lead

Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines; ensure compliance with local, state, and federal regulations Assess patients prior to initiation of home care service for appropriateness of services prescrib

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connect

Manage overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership Provide expertise and customer service support to members, customers, and / or providers Identify and resolves operational problems using defined processes, expertise, and judgment Investigate claim and / or customer service

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Assess Medical Risk for the Company Review/Analyze Evidence of Insurability and determine appropriate course of action (e.g., request requirements, approve, rate, decline) Review/Analyze medical history of relevant populations (e.g., medical applications, APS, exams, claims history) to correctly and completely identify medical risk or potential increased risk of morbidity

Make calls to qualified members to provide information and answer questions about health plan programs. Provide "best in class" customer service to enrollees Meet established productivity, schedule adherence, and quality standards while maintaining good attendance. Identify, qualify, and engage members into the most appropriate health and wellness programs to meet their n

Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines; ensure compliance with local, state, and federal regulations Assess patients prior to initiation of home care service for appropriateness of services prescrib

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions, and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in

Work Life Balance/$10,000 Sign-On Bonus/Excellent Benefits/Fortune 5 Company!