Challenge can often be it's own reward. But why settle for just being challenged when you can also be nurtured, mentored and supported as you make an impact in a fast paced career? As an ELITE ADVOCATE for UNITEDHEALTHCARE, you'll be responsible for building trust with members across their health care lifecycle. This function is responsible for assisting members with medical and pharmacy benefits, eligibility, claim resolution, triaging dental and vision issues, assisting with plan selection and enrollment, and improving health care literacy. This function is also responsible for multiple types of claim payment adjustments, including closed claims and denied claims. This function is expected to identify opportunities to resolve member issues timely.

PRIMARY RESPONSIBILITIES:

• Provides premium level service, removing burdens and providing end-to-end resolution for members. This includes, but is not limited to: Clinical, Financial Decision Support, Behavioral Support, Claims inquiries, and more.
• Provide single point of contact for the member for highly designated or dedicated UHC national or key account insurance plans
• Respond to and own consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx Pharmacy, Optum Behavioral Health and self-service options.
• Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
• Educate members about the fundamentals and benefits of consumer-driven health care topics to include managing their health and well-being so they can select the best benefit plan options and maximize the value of their health plan benefits.
• Advocate and intervene with care providers (doctor's offices) on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations.
• Assist the member with resolution as their advocate with 3rd party vendors
• Assist members in navigating myuhc.com and other UnitedHealth Group websites or applications utilizing remote desktop system capabilities
• Communicate and keep consumer informed through the means in which they prefer, i.e. Phone Call, secure messaging, e-mail or chat
• Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.
• Meet the performance goals established for the position in the areas of: conversation effectiveness, call quality, member satisfaction, first call resolution, efficiency and attendance.

ADDITIONAL RESPONSIBILITIES:

• Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans
• Performs claims adjustments/dollar payments to providers and/or members ultimately impacting UHC costs or commercial account costs
• Effectively refer and enroll members to appropriate internal specialists and programs, based on member's needs and eligibility using multiple databases
• Interpret and translate clinical / medical terminology into simple-to-understand terms for members
• Respond to and resolve on the first call, member service inquires and issues by identifying the topic and type of assistance the caller needs, such as; benefits, eligibility and claims, financial spending accounts and correspondence.
• Navigate through multiple platforms and databases to retrieve information regarding medical plans, prescription plans, flexible spending accounts, health reimbursement accounts, vision plans, dental plans, employer-based reward plans, claims submissions, clinical programs, etc.
• Must remain current on all communicated changes in process and policies / guidelines. Adapt to all process changes quickly, and maintain knowledge of changes at site level and entity level by utilizing all available resources.

Resolve member service inquiries related to:

• Medical benefits, eligibility and claims
• Terminology and plan design
• Financial spending accounts
• Pharmacy benefits, eligibility and claims
• Correspondence requests

Educate members about the fundamentals of health care benefits including:

• Managing health and well-being programs
• Maximizing the value of their health plan benefits
• Selecting the best health plan to meet their health needs
• Choosing a quality care provider and appointment scheduling
• Premium provider education and steerage
• Pre-authorization and pre-determination requests and status
• Benefit interpretation
• Self-service tools and resources
• Healthcare literacy (correspondence and literature interpretation)
• Work directly with site leadership to remove process barriers
• Navigate multiple online resource materials and follow defined process for issue handling
• Maximize use of community services, support programs, and resources available to member

REQUIRED QUALIFICATIONS:

• High School Diploma/GED or equivalent years of experience
• 1+ years' experience in a customer service related environment

PREFERRED QUALIFICATIONS:

• Associate's degree or higher
• Experience in Health Care/Insurance environment, preferred (Familiarity with medical terminology, health plan documents, or benefit plan design)
• Member service skills and experience

SOFT SKILLS,KNOWLEDGE, AND ABILITIES:

• Exceptional written and oral communication skills adaptable to live phone conversations as well as e-mail or chat exchanges that drive a trusted relationship based on ownership reducing customer effort
• Ability to quickly build rapport and respond to members in a compassionate manner by identifying and exceeding member expectations (responding in respectful, timely manner and delivering on commitments)
• Ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
• Proficient problem solving approach to quickly assess current state and formulate recommendations
• Flexibility to customize approach to meet all types of member communication styles and personalities
• Ability to overcome objections and persuade members to take action / change behavior
• Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions members can understand and act upon
• Excellent conflict management skills including:
• Professionally and adeptly resolving issues while under stress
• Diffuse conflict and member distress
• Demonstrate personal resilience
• Ability to utilize multiple systems/platforms while on a call with a member - strong computer skills and technical aptitude
• Strong attention to detail
• Strong ability to view change and transition in a positive way, and easily adapt to all updated requirements of the role
• Contribute to achieving the company's mission.
• Show commitment to team success over personal success. Work collaboratively with others to achieve goals
• Model UnitedHealth Group's Principles of Integrity and Compliance, and adhere to our business principles
• Maintain the confidentiality of sensitive information

CAREERS WITH UNITEDHEALTHCARE. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do YOUR LIFE'S BEST WORK.

DIVERSITY CREATES A HEALTHIER ATMOSPHERE: UNITEDHEALTH GROUP IS AN EQUAL EMPLOYMENT OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER AND ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, AGE, NATIONAL ORIGIN, PROTECTED VETERAN STATUS, DISABILITY STATUS, SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, MARITAL STATUS, GENETIC INFORMATION, OR ANY OTHER CHARACTERISTIC PROTECTED BY LAW. UNITEDHEALTH GROUP IS A DRUG-FREE WORKPLACE. CANDIDATES ARE REQUIRED TO PASS A DRUG TEST BEFORE BEGINNING EMPLOYMENT.

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.