Premier Customer Service Advocate - Remote in Richardson, TX

Company: UnitedHealth Group
Location: Orlando
Posted on: September 13, 2023

Job Description:

If you are located within 50 miles radius from 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
The role of the Premier Super Advocate is to support and handle complex member scenarios as well as follow and support members with more complex and/or chronic medical conditions requiring higher system utilization by identification through contacts with the call center. - The Super-Advocate's responsibility is to provide resolution for escalated and repeat calls and focus on members who are/have the potential for higher system utilization to provide evidence-based support and services
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 10:35am - 7:05pm 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 18 weeks of paid training. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. - Training will be conducted virtually from your home. Please note that 100% attendance during training is Required; No PTO during this time.
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Primary Responsibilities: -

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• Provide premium or elite level, proactive support, and service with end-to-end resolution for members, using their preferred communication method.
  
• Resolve escalated and complex calls/claim adjustments/issues from members that front line advocates are unable to resolve or need assistance on, working directly with business partners to make decisions regarding claim reconsiderations, prior authorizations, and appeal considerations.
  
• Engage in real time collaboration with appropriate clinical partners to resolve member concerns, connecting them with clinical programs and resources as needed.
  
• Act as a Subject Matter Expert (SME) for benefits and claims (Call & Digital) to provide real time guidance to advocates who may need help to resolve a member issue. Act as the primary contact for Service Account Managers.
  
• Provide support, coaching, technical training and feedback to other advocates regarding best practices. Work with supervisors to suggest or identify training or resource needs to enhance performance and manage ORS inventory at the team/client level.
  
• Identify gaps in process, work with business partners to determine new processes, write/communicate process changes.
  
• Own relationships and interactions with chronic issues or complex client micro populations such as Special Needs or Transgender members providing end to end resolution for members, using their preferred communication method.
  
• Facilitate proactive outbound calls when necessary to educate members on the best use of the benefits, to welcome new members to UHC, etc., owning the close-loop process.
  
• 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, proactive member engagement with clinical referrals, lower cost Rx alternatives, portal promotion, provider steerage to in-network providers, efficiency, and attendance.
  
• Support escalated members and staff when a member asks to speak to a supervisor, or the front-line advocate needs assistance in de-escalating an upset member. -
  
• Perform all job functions required as an Elite or Premier Advocate.
  
• Complete outbound calls to close the loop with members who express dissatisfaction with issue resolution or service via the post call survey after speaking to an advocate.
  
• Work with partners including medical, clinical, financial, behavioral and Rx to resolve issues as needed.
  
• Maximize use of community services, support programs and resources available to the 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: -
  
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  • High School Diploma / GED (or higher) OR equivalent work experience
    
  • Minimum of 1+ years of experience helping, resolving, or advocating on behalf of members or customers
    
  • Experience 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 40 hours per week Monday through Friday, 10:35am - 7:05pm CST
    
    Preferred Qualifications:
    
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    • 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/Advocate Experience
      
    • Claims processing experience
      
    • Experience within a member focused healthcare environment
      
      Telecommuting Requirements:
      
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      • Reside within 50 miles radius from Richardson, TX
        
      • 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:
        
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        • Exceptional 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
          
        • Excellent conflict management skills including:
          
        • Professionally and adeptly resolving issues while under stress
          
        • Diffuse conflict and member distress
          
        • Demonstrate personal resilience
          
        • Ability to utilize multiple systems/platforms while on a call with a member - strong computer skills and technical aptitude
          
        • Strong attention to detail
          
        • Strong 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
          
          At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for 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.
          
          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.
          #RPO #YELLOW

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