Provider Service Representative

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.

Schedule: Mon - Fri 8:00AM - 5:00PM

Location: 3990 Concours Suite 500, Ontario, CA

Primary Responsibilities:

• Assist in end-to-end provider claims and help enhance call quality
• Assist in the design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
• Support development and management of provider networks
• Help implement training and development of external providers through education programs
• Supports and remains accessible to providers and their office staff. Leaves specific instructions about how to be reached within and outside the office. Utilizes email and the cell phone to maintain productivity within and outside the office. Schedules regular visits with physician offices to provide education, training and customer service. Establishes and maintains strong, productive relationships with office staff by providing superior customer service and effectively solving issues. Stays current with activities in the market by developing an open rapport with the offices. Represents the IPA in all meetings with network providers in an appropriate and professional manner. Collaborates with leadership to prioritize high- impact providers and proactively address network challenges
• Coordinates and conducts meetings within assigned within the provider networks. Sends announcements regarding scheduled meetings, makes phone calls to verify attendance (quorum), orders refreshments and sets up/breaks down the meetings. Prepares, or directs the preparation of, agendas, handouts and meeting minutes. Represents management at all meetings with clients in an appropriate and professional manner
• Serves as a resource for network provider issues. Supports the Client Services Department in resolving provider issues and responds to training needs identified by other MSO departments such as Claims and Medical Management. Interfaces with Health Plan staff as required. Effectively problem solves issues as identified; documents all contact with providers/office staff in the provider's file. Monitors client needs to evaluate satisfaction levels, and identifies trends and areas requiring improvement. Identifies recurring issues and collaborates with teams to refine training content and improve cross-departmental processes
• Identify gaps in network composition and services to assist network contracting and development teams
• All other duties as assigned

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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
• 3+ years of managed care or medical insurance experience with provider network management (to include provider claims, credentialing, contract documentation and configuration processing required. Knowledgeable of HMO, Commercial, Medicare, Medicaid lines of business)
• 1+ years of experience with communication skills including telephone etiquette
• 1+ year of experience managing provider network
• Intermediate level of proficiency with Microsoft Office programs including Excel and Word

Preferred Qualifications:

• Bilingual (English/Spanish)

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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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