Premier Customer Service Advocate (Apple Hub) – Remote in Richardson, TX

If you are located within a 50-mile radius of Richardson, TX office, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

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 and start doing your life’s best work.^SM

This position is full-time (40 hours / week), Monday – Friday. Employees are required to work any shift between the hours of 1:30 PM – 10:00 PM CST It may be necessary, given the business need, to work occasional overtime. Our office is located at 1311 W Pres George Bush Highway, Richardson, TX, 75080.

We offer a minimum of 24 weeks of paid training. The 1st week of training will be on – site (The hours during training will be 8:00 AM – 4:30PM CST from Monday – Friday) and then training will continue remote for the rest of the 23 weeks. Additional 30 days of post training required to come on – site (The hours during training will be 8:00 AM – 4:30PM CST from Tuesday – Thursday). 100% attendance is required. No PTO.

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

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

This role is equally challenging and rewarding. You’ll be called on to research complex issues pertaining to the caller’s health, status and potential plan options. To do this, you’ll need to navigate across multiple databases which requires fluency in computer navigation and toggling while confidently and compassionately engaging with the caller.

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 
• Minimum of 3+ years of experience with helping, resolving, OR advocating on behalf of members OR customers
• 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 shift between the hours of 1:30 PM – 10:00 PM CST from Monday – Friday
• Must be 18 years of age OR older

Preferred Qualifications:

• 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)
• Sales OR account management experience
• Customer Service experience
• Claims processing experience
• Experience within a member – focused healthcare environment

Telecommuting Requirements:

• Reside within a 50-mile radius of Richardson, TX office
• 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