Customer Service Representative, UnitedHealth Group

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 (8:00am – 5:00pm). It may be necessary, given the business need, to work occasional overtime.

The primary purpose of this position is three-fold:

• Onboarding: Ensuring members understand their personal plan of care and are connected to their provider
• Outreach: Helping members access the care they need, based on quality goals through identifying gaps in care, access and services.
• Member Support: Providing high quality escalated member support for tough to solve issues

Those in this role will utilize scripting, a call anatomy, and critical thinking skills to welcome members to their plans, understand how their benefits support their health, connect members with providers to deliver health care services, assist members in accessing community services to meet basic needs, and connect members to clinical or psychosocial resources should they need further assistance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

(While following all PHI and HIPAA guidelines)

• Work via an outbound autodialer, contact newly enrolled members as identified by the Basis team to welcome them to our health plans. The primary goal of this interaction is to develop a positive relationship and ensure the member has the information and documentation they need to have a positive experience as our member.
• Welcome the member to their respective health plan by verifying key information about the member (home address, Primary Care Physician (PCP) assignment, etc.) and discussing the benefits available through the plan.
• Following a call anatomy, connect with the member to establish a trusting relationship and, utilizing job aids and critical thinking skills, assess the barriers that are prohibiting the member from seeking the proper care, and answer members question about benefits.
• If Barrier to Care is provider related the agent will assist the member with finding a new doctor and working with provider’s office to set up new appointment.
• If Member is identified as having an issue meeting basic needs the agent would help connect the member to community resources.
• When appropriate, agents would need to escalate members to social or clinical resources for members requiring more specialized support.
• Work offline to resolve member barriers to care requiring more research and follow-up with the member to help remove care barriers.
• When appropriate, encourage members to appropriately utilize services in an effort to improve the health and well being of all members. This might include education about the importance of using the Emergency Room (ER) only in true emergencies.
• Complete a Health Risk Assessment (HRA) following the UnitedHealthcare national standard HRA.
• When possible, correct member information in our databases, including the member’s address, PCP assignment.
• When possible, order replacement member materials (ID cards, welcome packets) if a member reports that they have not received them or if the member has had a change of address.
• Document member responses and call outcomes in the appropriate system.

Other Duties, as Appropriate and Assigned

• Assist with projects and/or assignments designated by the Supervisor or Manager.
• Provide input into the development of policies and procedures that affect the program or department. Give input into improving member education strategies and materials.
• Actively participate in departmental quality improvement monitoring and other activities to promote the delivery of high-quality services to all customers.

Required Qualifications:

• High School diploma / GED (or higher)
• 1+ year of call center experience, inbound or outbound
• 2+ years of experience in customer service

Preferred Qualifications:

• Healthcare insurance experience
• Clinical, social work or nursing experience background
• Experience working in a healthcare / social services environment clinical or nursing
• Medicaid and/or managed care experience with knowledge of community-based programs
• Experience working with low-income populations

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability 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

Soft Skills:

• Strong commitment to customer service and helping members access the benefits and services they need to live healthier lives
• Ability to interact well and work cooperatively with individuals of all professional and non-professional levels.
• Excellent time management skills and computer literacy or ability to learn.
• Excellent written and oral communication skills.
• Ability and flexibility to assume tasks in a changing work environment
• Strong service orientation with a drive to help people solve complex issues

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