Client Service Specialist – National Remote

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on 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. Connecting. Growing together. 

This position supports the NY, PA, & VA plans. This role is critical to supporting state and plan requirements as well as improving service to members and providers. It will be challenging for the East Region Pharmacy team to complete our mission without this resource.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities: 

• Member Advocate Resource
  • Member complaints, A&G
  • Member denials of prior auth requests
  • Pharmacy claim rejects
  • Outreach to ORx
• Pharmacy Issues
  • COB
  • Overrides placed for OON pharmacy
  • DMR’s
• Audits
  • State
  • NCQA
  • EQRO
  • DHS Denial letters
• Reporting
  • Denial Logs
  • Statewide PDL Approval/Denial Report
  • Lock-In Report
  • CMC Changes
  • Member appeal to Lock-In
  • Monthly CMC report sent to MDH
• Help C Reporting
  • Aggregate Audit – bi-annual
  • Retrieval of 12 week- SVR
  • Reconciling bi-annual report
  • Packaging the submission
• Compiles member packets for state audits monthly 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 higher)
• Active Pharmacy Technician license in state of residence or PTCB, or ability to obtain within 1 year of starting employment in position
• 2+ years of experience working within a pharmacy, PBM, or health plans
• 1+ years of previous customer service or call center experience
• 1+ years of experience and understanding with RxClaim
• Intermediate level of proficiency with MS Office software (Excel – VLOOKUP, PIVOT, PPT, Word, Teams)

Preferred Qualifications: 

• Undergraduate Degree
• Familiarity with medication names and conditions
• Previous knowledge of Medicare pricing or Medicare-managed pharmacies
• Good business phone skills

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

For more information on our Internal Job Posting Policy, click here.

 

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 $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

 

 

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