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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Like you, Optum, part of the UnitedHealth Group family of businesses is solid on innovation. And like you, we'll go the distance to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have a chance to make an impact.

Primary Responsibilities:

• Manage the intake of members or the admission/discharge information post notification
• Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers
• Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles
• Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention
• Handle resolution/inquiries from members and/or providers
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours.

Required Qualifications:

• HS Diploma or GED
• 1+ years of customer service experience analyzing and solving customer problems
• Ability to create, edit, save and send documents utilizing Microsoft Word and Excel
• Ability to type and talk at the same time and navigate through multiple screens

Preferred Qualifications:

• Experience working within the health care Industry and with health care insurance
• Experience working with Medicare and/or Medicaid Services
• Experience working in a metric-driven work environment
• Call center experience
• Knowledge of ICD-9 and CPT codes
• A clerical or administrative support background

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.

Optum is a drug-free workplace. © 2025 Optum Global Solutions (Philippines) Inc. All rights reserved.