Energize your career with one of Healthcare’s fastest growing companies.
You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
The purpose of this role is to guide and educate members to maximize the value of their health benefits program, connect them with quality care providers, and advocate for resolution of any issues or barriers that arise.
- Engage, serve, and delight members while providing full issue resolution, proactive education, and a high level of personal service. Assistance and education may be provided via inbound or outbound calls in support of multiple health plans, products, and programs including Dual Special Needs (DSNP), Medicare/Medicaid Programs (MMP), Managed Long Term Services and Support (MLTSS) and others as business needs dictate.
- Meet compliance requirements set forth by the Centers for Medicare and Medicaid Services such as those related to Verbal Grievance (VG), Organizational Determination (OD), Coverage Determination (CD), and Complaints to Medicare (CTM).
- Respond to and resolve, on the first call, customer service inquiries and issues by identifying the topic and type of assistance the caller needs such as (sample, not all-inclusive)
- Benefits, eligibility and claims
- Terminology and plan design
- Premium payments, financial spending accounts
- Pharmacy and other ancillary benefits, eligibility and claims
- Correspondence requests
- Pre-authorizations or pre-determination requests
- Access to care through transportation benefits and schedule transportation
- Take ownership of issues and see them through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member, meeting standards for turn-around-time set by the department.
- Contact care providers on behalf of the customer to assist with appointment scheduling or referrals to specialists for assistance.
- Make proactive outbound calls to members. Purpose of the calls may be: to welcome newly enrolled members to our health plans, address gaps in care, verify services and other as specified in the individual campaign. Refer and enroll members to appropriate internal specialists and programs, based on member’s needs and eligibility.
- Achieve performance standards set by the business for quality, customer experience, efficiency, first call resolution, and others while maintaining acceptable attendance according to policy and guidelines.
- Other Duties, as appropriate and assigned may include:
- As business needs dictate participate in cross-training and support of other UHG business
- Assist with projects and/or assignments designated by the Supervisor or Manager.
- Research complex issues across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues.
- Provide input into the development of policies and procedures that affect the program or department. .
- Actively participate in departmental quality improvement monitoring and other activities to promote the delivery of high quality services to all customers.
- Assist Supervisor with orientation/training of new employees as assigned
- Contributes to achieving the company’s mission.
- Model UnitedHealth Group's Principles of Integrity and Compliance, and adhere to our business principles
- Maintain the confidentiality of sensitive information
- Work collaboratively with others to achieve goals/Team Player
- High School Diploma / GED (or higher)
- 2+ years of experience in a Customer Service environment
- 2+ years of experience in a health care related field with requisite experience working with either Long Term Support and Service (LTSS) or Behavioral Health populations
- Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
- 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
- Undergraduate Degree (or higher)
- 1+ years of experience supporting Community and State outbound calls
- 6+ months of prior experience in a United Healthcare call center role
- Experience working with low-income populations, and have demonstrated expertise in topics related to LTSS, resiliency and recovery and Cultural Competency
- Strong computer skills and technical aptitude in Microsoft Outlook (email and calendaring) and Microsoft Word (creating, editing, saving documents)
- Ability to diffuse conflict and member distress to resolve issues
- Ability to problem solve to quickly assess current state and formulate recommendations
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner and delivering on commitments)
- Ability to utilize multiple systems/platforms while on a call with a member
- Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
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, Behavioral Health, LTSS, issue resolution, call center, Optum, UHG, community and state, member advocate