Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
This role is responsible for providing expert assistance, expertise, and customer service support to newly trained and/or tenured call center agents. The primary responsibility is to provide direct telephonic customer service to answer and resolve a wide variety of inquiries, handle escalated calls when a caller requests support from someone other than the front line staff to resolve or find a solution to their issue or dispute, and provide call trend feedback to leadership and training team.
- Support the development and success of newly trained and/or tenured agents
- Respond to the agents emotional needs, making every interaction with staff friendly, compassionate and positive.
- Handle escalated calls when a caller requests support from someone other than the front line staff to resolve or find a solution to their issue or dispute.
- Provide weekly summaries of call drivers, trends and outliers to leadership and training teams.
- Demonstrate understanding of internal/external factors that may drive caller questions/issues (e.g., recent plan changes, mass mailings, call directing/rerouting, weather emergencies)
- Ask appropriate questions and listen actively to identify underlying questions/issues (e.g., root cause analysis)
- Gather appropriate data/information and perform initial investigation to determine scope and depth of question/issue
- Identify and coordinate internal resources across multiple departments to address client situations, and escalate to appropriate resources as needed
- Proactively contact external resources as needed to address caller questions/issues (e.g., providers, labs, brokers)
- Utilize appropriate knowledge resources to drive resolution of applicable questions/issues (e.g., websites, CRM tools, Onyx, Siebel, knowledge bases, product manuals, SharePoint), using appropriate problem solving skills and established guidelines and procedures.
- Identify and communicate steps/solutions to caller questions/issues, using appropriate problem-solving skills and established guidelines, where available (e.g., workarounds, descriptions of relevant processes)
- Offer additional options to provide solutions/positive outcomes for callers (e.g., online access to relevant information, additional plan benefits, workarounds for prescription delays)
- Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, brokers, pharmacies)
- Drive resolution of caller questions/issues on the first call whenever possible (e.g., first-call resolution, one-and-done)
- Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution)
- Manage caller conversations appropriately (e.g., provide a good first impression, command attention and respect, maintain professional tone, demonstrate confidence, de-escalate/defuse callers as needed)
- Apply knowledge of applicable Service Level Agreements (SLAs) and Performance Guarantees when interacting with callers
- Maintain ongoing communications with callers during the resolution process to communicate status updates and other required information
- Maintain focus on caller interactions without being distracted by other factors (e.g., system usage, pop-up alerts, VCC data)
- Acknowledge and demonstrate empathy/sympathy with callers' life events (e.g., wedding, birth of baby, loss of relative, recent illness)
- Demonstrate knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision)
- Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, COBRA, FSA, HRA)
- Obtain and apply knowledge of benefit structures/designs for contracted or acquired companies
- Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements)
- Maintain knowledge of information/process changes due to healthcare reform, referring to applicable company resources (e.g., dependent age, removal of lifetime limits, free preventive care services, Medical Loss Ratio)
- Demonstrate knowledge of established workflows and support processes (e.g., available resources, internal/external business partners, points of contact)
- Demonstrate knowledge of relevant internal processes impacting caller issues (e.g., claims processing, auto-adjudication)
- Identify inaccurate/inconsistent information found in systems/tools, and communicate to appropriate resources (e.g., IBAAG, SOP, AYS, SPDs, policies/procedures)
- High School Diploma or GED
- 2+ years call center or customer service experience with demonstrated career progression in a customer service capacity
- Intermediate computer skills, with an emphasis on Microsoft Word (creating and editing documents) and Microsoft Outlook (email and calendar)
- Ability to work an 8 hr shift between 7:30am EST - 8:30pm EST and occasionally on Saturday 10am - 5:30pm (in lieu of another weekday)
- Associate’s Degree or higher
- Experience with Microsoft Excel (create and edit data in spreadsheets, utilize functions and formulas), Microsoft OneNote (place content, open and create notebook), Microsoft PowerPoint (create presentation slides, diagram) and Microsoft Publisher (create, personalize and share publications and marketing materials) is an asset
- Knowledge of any other software, applications, database, web portal and / or equipment would be an asset
- Excellent verbal and written communication skills including, strong telephone etiquette and interpersonal skills
- Exhibit solid organizational skills, initiatives flexibility, time management and attention to detail in a goal - orientated environment
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM
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.
Keywords: customer service representative, intake specialist, escalations, call center, healthcare, Optum