Healthcare EDI Analyst jobs in New London, CT

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. Connecting. Growing together.  

Responsible for first-level response and resolution or triage of escalated issues with external and internal customers. Responsible for the overall delivery of benefits and services by providing on-site support and guidance to client. Acts as outward-facing, dedicated resource with direct client contacts for large or complex client issues. Builds relationships with employer and serves as the primary point of contact for day-to- day operational service delivery. Represents client internally and coordinates with other functions to infuse call / claim service delivery expectations, complete projects, and address ongoing service needs.

Location: 75 Eastern Point Rd Groton, CT 06340

Schedule: Monday through Friday from 8am-5pm EST

Primary Responsibilities: 

• Investigate and manage escalated claim/call/appeals issues through root cause analysis and communicate outcome (in person, telephonically or via written communication)
• Assist with navigating the healthcare system by providing resources for scheduling appt. and assisting with issues related to prolong periods for scheduling appts
• Assist participants with completing health care issues by facilitating interactions with customer service resources, case management and providers
• Document and track all issues and activities accurately to includes quantify of people assisted, whether it was in person vs. virtual, the issue and the resolution.
• Simplify and personalize interactions with members and Electric Boat to align with evolving service/quality expectations and single point of contact demands. (Deliver simply great service)
• Track, trend and proactively review accounts for service opportunities
• Drive process improvement based on trend analysis
• Identify and report system problems in relation with benefit installation and interpretation
• Complete ad hoc report requests and analysis
• Complete and deliver Performance Guarantee reporting related to calls and claims
• Drive excellence in service within organization and across organization by providing feedback to Operations on service failures
• Attend Account Management and client meetings representing call and claims
• Lead service remediation efforts and a final report back on these efforts
• Develop and deliver customer specific (benefit, claim, and cultural) training to internal call and claim teams
• Lead process improvement special projects and work teams for dedicated client and potential global impact
• Support Open Enrollment (i.e. updating open enrollment database, training call teams, benefit fairs, vendor summits etc.)
• Work with Unions as needed related to benefit issues and activities
• Occasional travel required

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 or higher
• 5 years of customer service experience OR 3 years of customer management experience 
• 3 years of experience in healthcare benefits and/or claims 
• Ability to work in office at 75 Eastern Point Rd Groton, CT 06340 Monday through Friday from 8am-5pm EST
• Ability to travel up to 55 miles apart up to 25% of the time
• Intermediate level of proficiency with Microsoft Office

Preferred Qualifications:

• Experience working with UNET
• Experience working onsite with a client
• Experience working with unions
• Experience working with healthcare providers
• Familiarity with manufacturing environments

Soft Skills:

• Superior customer service skills
• Leadership skills
• Strong verbal and written communication skills
• Problem - solving skills

#RPO #Red