Job title: Elite Super Advocate – National Remote
Company: UnitedHealth Group
Job description: 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.The role of the Elite Super Advocate is to support and handle complex member scenarios as well as follow and support members with more complex and / or chronic medical conditions requiring higher system utilization by identification through contacts with the call center.This position is full-time (40-Hours/week). Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 8:00pm CST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime.You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
- Coaching and mentoring others, by answering agent questions, assisting them with resolution as Subject Matter Expert
- Resolves escalated complex and repeat calls from members and works directly with business partners (complex claim reconsideration, notifications, appeal considerations)
- Adjudicates complex claims
- Monitors and provides proactive support to members with more chronic member issues
- Works with partners including medical, clinical, financial, behavioral and Rx to resolve issues
- Engages in real time collaboration with clinical partners including, Medical Director, CM / DM Nurses in resolving member concerns and engaging appropriate clinical programs and resources
- Writes / Communicates Process changes
- Works with supervisors on enhancing performance
Secondary 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
- Provides single point of contact for the member
- Supports member contact through multiple channels (incoming call, chat, secure messaging, proactive outbound)
- Responds 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
- Owns problem through to resolution on behalf of the member in real time or through comprehensive and timely follow – up with the member
- Educates 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 maximizes the value of their health plan benefits
- Advocates and intervenes with care providers (doctor’s offices) on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations
- Assists the member with resolution as their advocate with 3rd party vendors
- Assists members in navigating myuhc.com and other UnitedHealth Group websites or applications utilizing remote desktop system capabilities
- Communicates and keeps consumer informed through the means in which they prefer, i.e. Phone Call, e – mail, etc
- Research complex issues across multiple databases and work with support resources to resolve member issues and / or partner with others to resolve escalated issues
- Meets the performance goals established for the position in the areas of: conversation effectiveness, call quality, member satisfaction, first call resolution, efficiency and attendance
- Effectively refers and enrolls members to appropriate internal specialists and programs, based on member’s needs and eligibility using multiple databases
- Interprets and translates clinical / medical terminology into simple – to – understand terms for members
- Responds to and resolves 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
- Navigates 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
- Works directly with site leadership to remove process barriers
- Navigates multiple online resource materials and follow defined process for issue handling
- Maximizes use of community services, support programs, and resources available to member
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 equivalent work experience
- Must be 18 years of age OR Older
- 2+ years of experience in a customer service-related environment
- Experience within E&I Consumer Services as a T2, NPSR, Elite or Premier Customer Service Advocate
- Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 8:00pm CST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime
Preferred Qualifications:
- Experience in Health Care / Insurance environment (Familiarity with medical terminology, health plan documents, or benefit plan design)
- Experience within E&I Consumer Services as an Elite or Premier Customer Service Advocate
Telecommuting Requirements:
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft skills:
- Exceptional written and verbal communication skills
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyCalifornia, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $23.22 – $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.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.#RPO
Expected salary: $23.22 – 45.43 per hour
Location: Dallas, TX
Job date: Wed, 23 Oct 2024 22:32:28 GMT
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