Senior Complex Customer Care Representative - National Remote

Company: UnitedHealth Group
Location: Los Angeles
Posted on: January 28, 2023

Job Description:

You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work. SM This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 7am - 10pm CST. It may be necessary, given the business need, to work occasional overtime or weekends. All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary Responsibilities: Support inbound and outbound calls with an emphasis on excellent customer service in a high volume call center environment. Own member issues, questions, concerns, and see them through to resolution. Respond to members and providers in a polite and courteous manner,with patience, empathy, care, compassion, and sincerity in voice tone and pace. Assist members with medical and pharmacy benefits, medical plan overview, behavioral health inquiries, claims, provider search and prior authorization.Provide member education on HAS, FSA, HRA, and other financial accounts. Serve as a Health Care Advisor, going above and beyond for consumers, creating a memorable consumer experience, and providing expert, proactive service to members by:Finding creative ways to do more than what the member expectsDelighting each member by meeting their unexpressed needsLeaving each person feeling confident and cared for Provide services such as:Education to help simplify the healthcare system and validate members understanding of next best actionsAdvise members in choosing healthcare providers that meet and exceed consumer needsEducate members on clinical and wellness resources they can take advantage of to manage a health condition/disease or reach a wellness goalProvide education to members to assist in understanding benefits, terminology, claim resolution and Explanation of Benefit interpretationServe as an advocate by responding to, resolving and escalating complex claim issues with internal and external resources Initiate telephone calls to internal sources, membership, providers, and other claim payers to gather data and determine resolution to claim issuesRefer qualified members into Wellness and clinical programsSolve problems systematically, using sound business judgment, and following through on commitmentsConsistently meet established productivity, schedule adherence, meeting metric expectations, and quality audit standardsWork with cross carries to ensure member follow up and resoultuon. (cross carrier functions) Work with providers and plans to help ensure critical info is being relayed timely between the plan and the provider. Support multiple clients and their indiviuals expectations. Help Secure establishing patient appointments for the first time visit to the PCP.Provide community resources once internal resources have been exhausted (e.g.Financical assistant programs, Medical assistant program resources)Work with Network management to ensure panel request are up to date and when providers are not confirming to the contract (e.g.balance billing) 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: Associate's Degree (or higher) in related field2+ years of experience in a Call and Contact Center within the Healthcare Field/Financial Services, Advocacy Service, Customer Service, Sales, and Hospitality.Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer applications and apply their use while on the phone Proficiency with Microsoft Office (Excel, Word, Outlook, and PowerPoint) is required. Preferred Qualifications: Bachelor's degree (or higher) and background in the health care industryExperience with medical or health terminology Multi-lingual candidates (e.g. English/Spanish) Telecommuting Requirements: Required to have a dedicated work area established that is separated from other living areas and provides information privacyAbility to keep all company sensitive documents secure (if applicable)Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Skills and Experience Ability to understand and effectively explain complex benefit plans.Excellent customer service, interpersonal, communication, and organizational skills. Ability to overcome objections and persuade members to take action / change behaviorFlexibility to customize approach to meet all types of member communication styles and personalitiesExcellent interpersonal, written and verbal communication skills.Excellent problem solving and critical thinking skills to resolve complex healthcare issues.Strong attention to detail Quality focusedAbility to use multiple systems while assisting consumersExcellent conflict management skills includingAbility to resolve issues under stressDiffuse conflict and member distressAbility to organize and prioritize tasks efficiently Excellent interpersonal, written and verbal communication skills Ability to excel in a fast-paced work environment where constant learning, change, and multi-tasking is required 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. Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges. Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $18.17 - $32.26. The salary range for Connecticut / Nevada / New York City residents is $20.00 - $35.53. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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 To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. 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: UnitedHealth Group, Los Angeles , Senior Complex Customer Care Representative - National Remote, Other , Los Angeles, California