Senior Customer Service Representative

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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.

In this role, you play a critical role in creating a quality experience for the callers that you connect with and those that you correspond with. Every interaction gives you that opportunity to improve the lives of our customers and exceed their expectations. You'll spend the majority of your day by responding to calls from our providers, helping answer questions and resolve issues regarding health care eligibility, claims and payments. You may be asked to review and research incoming healthcare claims from providers (doctors, clinics, etc.) by navigating multiple computer systems and platforms to provide updates.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 6:00pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer 5 weeks of paid training starting 8/25/2025. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted virtually from your home.

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

Primary Responsibilities:

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  Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e., benefit, eligibility, authorizations for treatment, and claims

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  Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems

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  Own problem through to resolution on behalf of the caller in real time or through comprehensive and timely follow-up with the provider

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  Review and research incoming healthcare claims from providers (doctors, clinics, etc.) by navigating multiple computer systems and platforms to provide updates to providers

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  documents/certificates)

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  Communicate and collaborate with providers to resolve issues, using clear, simple language to ensure understanding

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  Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, customer satisfaction and attendance

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  This position will receive and handle both mostly provider calls: 50-60 daily.

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  Provider calls including UHN and non UHN networks (custom provider network questions from UMR medical provider customers such as hospital/clinic)

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  Handles unique customized employer benefit plans

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UMR as a TPA Supports:

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  Customers - are employers who use UMR as a TPA to administer their plans

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  Providers - are medical providers (hospital/clinic)

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  Members - are subscribers and dependents of self-insured employer plans

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  Brokers - are consultants that work with the employer who might call UMR's service team on a question/claim; calls from Brokers are nominal as they normally reach out directly to the Sales