A customer calls, frustrated because their recent claim was denied. How do you handle the call?
Why This Is Asked
This is not a verbatim reported question, but it reflects the healthcare-specific challenges Optum CSRs face daily, testing problem-solving, communication, and composure.
General Approach
Demonstrate the ability to de-escalate, educate the customer, and provide actionable steps. Balance empathy with efficiency.
Sample STAR Answer▾
Situation
I took a call from a policyholder who was visibly upset because her recent outpatient procedure was not covered by insurance.
Task
My goal was to clarify the denial reason, explore possible solutions, and calm the customer.
Action
First, I let her vent without interrupting, then I acknowledged her frustration sincerely. I pulled up her policy and, in plain language, explained that the specific clinic was out-of-network. I informed her that she could file an appeal and offered to email the appeal form along with a list of in-network providers for future needs.
Result
She appreciated the clear explanation and felt empowered to take the next steps. The call ended on a positive note, and she thanked me for my patience and guidance.
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