Claims Customer Service Representative

Posted 2 months ago

OptiMedHealth Plan, a United Group Programs Brand, is an industry leader in Healthcare Benefits. We offer tailored healthcare products for our clients, focusing on the highest level of plan satisfaction and optimization. We are also a full-service benefits organization and Third-Party Administrator (TPA) that provides a high degree of expertise in the design, communication, and administration of benefit programs. The company markets group Self-Funded Major Medical, GAP, Limited Medical, MEC / MVP, Critical Illness, Short and Long-Term Disability, Life, Dental, Vision, and Accident insurance products to brokers, which in turn sell the plans to their clients and prospective consumers.

OptiMed’s core strength is our people and their client centric approach to servicing agencies, brokers, members, providers, and our vast broker network. We have taken great pride in providing quality benefits and service for over half a century. Excellent customer service is our top priority.

Position Summary

OptiMed is seeking a qualified candidate for a Customer Service Representative position who will be responsible for providing expertise and customer service support to Members, Customers, and/or Providers: providing direct phone-based customer interaction to answer and resolve a wide variety of inquiries.


• Respond to and resolve customer service inquiries and issues by identifying the topic and type
of assistance the caller needs such as benefits, eligibility, claims, and correspondence
• Assist customers in website navigation and self-service options for their health plan
• Own a problem through to resolution on behalf of a member in real time or through comprehensive
and timely follow-up
• Escalate member and provider issues to appropriate team members, as defined by our
• Meet the performance goals established for the position in the areas of: efficiency, call
quality, customer satisfaction, first call resolution and attendance
• Proficient problem solving skills
• Proficient in translating healthcare-related terminology and complex processes into simple,
step-by-step instructions customers can understand and act upon
• Flexibility to customize approach to meet all types of member communication styles and
• Proficient conflict management skills to include ability to resolve issues and demonstrating
personal resilience
• Ability to work without constant direction from management
• Basic tasks are completed without review by others


• High School Diploma/GED (or higher)
• 1+ years of customer service experience
• Ability to successfully complete the UGP training program within the required time
• Ability to work regularly scheduled shifts within our hours of operation, where lunches and
breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or
weekends, as needed.


• Associate’s Degree (or higher)
• Health Care experience


Health Insurance
• 401(k) matching
• Dental
• Vision
• Short-Term and Long-Term Disability
• Life Insurance
• Paid Holidays
• Paid PTO

• Full-Time

Work Location

• Atlanta, GA

Apply Online