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Positions in this function are 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.
This position is full-time (40 hours/week) Monday- Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (7:00am - 10:00pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 12700 Whitewater Drive, Minnetonka, MN 55343.
There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application. Once you submit your completed application, you will receive an e-mail with information regarding next steps including any pre-employment assessment(s) that are required. Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: http://uhg.hr/OurApplicationProcess
Provide 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.
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, 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.
Meet the performance goals established for the position in the areas of: conversation effectiveness, call quality, member satisfaction, first call resolution, efficiency and attendance.
Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans
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
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
1+ year of Customer Service Advocate experience
High school diploma, GED (or higher) or equivalent work experience
Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
Demonstrated ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
Proficient in translating health care-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
Proficient conflict management skills to resolve issues in a stressful situation
Prior Healthcare experience
UnitedHealth Group is a team of more than 200,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SM
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.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.
Key words: UnitedHealth Group, UnitedHealthcare, Optum, training class, customer service representative, customer service, CSR, inbound calls, Call Center