Premier Customer Service Advocate - Apple Hub - National Remote in Richardson, TX

Job title: Premier Customer Service Advocate - Apple Hub - National Remote in Richardson, TX at UnitedHealth Group
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.As a Premier Customer Service Advocate you'll be 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 an 8-hour shift schedule during our normal business hours of 1:30 pm - 10:00 pm CST. It may be necessary, given the business need, to work occasional overtime.We offer 11 weeks of training. The hours during training will be 8:00 am - 4:30 pm CST from Monday - Friday 100% attendance is required. NO PTO.You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary 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
• Provide single point of contact for the member for highly designated or dedicated UHC national or key account insurance plans
• 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, secure messaging, e-mail or chat
• 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

Additional Responsibilities:

• Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans
• Performs claims adjustments/dollar payments to providers and/or members ultimately impacting UHC costs or commercial account costs
• 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
• Correspondence requests
• 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
• Benefit interpretation
• Self-service tools and resources
• Healthcare literacy (correspondence and literature interpretation)
• Work directly with site leadership to remove process barriers
• Navigate multiple online resource materials and follow defined process for issue handling
• Maximize 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
• 1+ years of experience with helping, resolving, OR advocating on behalf of members or customers
• Current Tier I UNET Advocate for Me experience
• Current E and I Ops Consumer Services Experience
• Experience with using a computer and Microsoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), and Microsoft Outlook (email and calendar management)
• Ability to work any of our 8-hour shift schedules during our normal business hours of 1:30 pm - 10:00 pm CST from Monday - Friday including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

• Sales OR account management experience
• Health Care / Insurance environment (familiarity with medical terminology, health plan documents, OR benefit plan design)
• Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)

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:

• Written and oral communication skills adaptable to live phone conversations as well as e-mail OR chat exchanges that drive a trusted relationship based on ownership reducing customer effort
• Ability to quickly build rapport and respond to members in a compassionate manner by identifying and exceeding member expectations (responding in respectful, timely manner and delivering on commitments)
• Ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the members
• Proficient problem-solving approach to quickly assess current state and formulate recommendations
• Flexibility to customize approach to meet all types of member communication styles and personalities
• Ability to overcome objections and persuade members to take action / change behavior
• Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions members can understand and act upon
• Conflict management skills including:
• Professionally and adeptly resolving issues while under stress
• Diffuse conflict and member distress
• Personal resilience
• Ability to utilize multiple systems / platforms while on a call with a member - strong computer skills and technical aptitude
• Attention to detail
• Ability to view change and transition in a positive way, and easily adapt to all updated requirements of the role
• Contribute to achieving the company’s mission
• Show commitment to team success over personal success. Work collaboratively with others to achieve goals
• Model UnitedHealth Group's Principles of Integrity and Compliance, and adhere to our business principles
• Maintain the confidentiality of sensitive information

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyThe hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. 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.UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#RPO
Expected salary: $19.86 - 38.85 per hour
Location: Richardson, TX
Job date: Thu, 01 May 2025 22:17:39 GMT
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