Job was saved successfully.
Job was removed from Saved Jobs.

Job Details

UnitedHealth Group

Customer Care Advocate (DSNP) - Remote (100235874)

Customer Service

Customer Care Representative



Dallas, Texas, United States

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

As a concierge service structure, navigators serve as the primary point of contact for all customer service issues. Day to day functions include inbound/outbound calls from/to assigned members and member account research with focus on issue resolution. As a navigator you’ll assist with end to end issue identification and resolution.

Dual Special Needs Plans (DSNP): This role will work one-on-one with assigned clinical and non-clinical staff supporting members and their caregivers associated with that assignment in a case management capacity, with a primary focus on closing gaps in care. Daily responsibilities include taking an ownership mindset when engaging with assigned panel of approximately 600 members.

Service Led: This role is responsible for supporting members who are experiencing a challenging health event that requires additional interaction with the healthcare system. Health events include, but are not limited to, hip or knee replacement, heart attack or stroke, or a recent cancer diagnosis. In this role, navigators will manage a panel of members and their healthcare needs, address service needs both proactively and reactively, and facilitate a seamless return to steady state

Clinical Led: This role is responsible for coordination of member navigation plans with Optum clinical and non - clinical staff supporting members in the Navigate4Me program including members referred for CHF, DHN, PSU, HPC, Advanced Illness, ESRD and Transplant. This role will work one-on-one with assigned Optum clinical and non-clinical staff and will support members and their caregivers associated with that assignment in a case management capacity.

Medicaid Navigation: This role will work one-on-one with assigned Medicaid eligible members and their caregivers with a primary focus on identifying and supporting member needs in partnership with clinical and case management resources. Daily responsibilities include taking an ownership mindset when engaging with an assigned panel of members, end-to-end ownership and resolution of member issues, and driving positive health outcomes.

HTCT – High Touch Call Team – In addition to DSNP responsibilities, this role will make outbound phone calls to complete Health Risk Assessments for DSNP members as well as outbound campaigns as requested by our health plan partners to better serve our members or handle emergency situations (storms, wild fires, etc.). The HTCT also provides support for the Engagement Room (ER) as a central point for other lines of business and partners to send members who need to contact their assigned Navigator.

High Risk: This role will work one-on-one with assigned members and their caregivers, with primary focus on identifying and supporting member service needs. Daily responsibilities include taking an ownership mindset when engaging with assigned members, end-to-end ownership and resolution of member issues, and driving positive health outcomes. This role is focused on managing Inbound calls, with occasional outbound calls as needed to resolve issues.

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 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer 8 weeks of paid training. The hours during training will be 8:00am – 5 pm CST Monday-Friday. Training will be conducted virtually from your home.

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

Primary Responsibilities:

  • Best in class dedicated customer service agent which provides concierge and white-glove level service, removing burdens and providing end-to-end resolution for customers. This includes, but is not limited to, clinical, financial decision support, behavioral support, claims inquiries, and more.
  • Agents will provide a single point of contact for the customer. This gives customers the opportunity to form a relationship with their own concierge.
  • 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.
  • Conduct proactive research on assigned member accounts to identify service issues and inform member plan of navigation in coordination with clinical and/or non-clinical staff outreach. Research includes, but is not limited to:
    • Recent contacts
    • Alerts
    • PCP on account
    • LIS
    • Medicaid
    • Appeals
    • Billing
    • Claim Denials
    • PAs
    • Mail Order
    • Transportation
  • Communicate with assigned clinical and/or non-clinical staff with the Health Plan regarding member service issues that are proactively identified, member identified and close the loop on the resolution of service issues to inform the plan of navigation for assigned members.
  • Resolve member service inquiries related to:
    • Medical benefits, eligibility and claims
    • Terminology and plan design
    • Financial spending accounts
    • Pharmacy benefits, eligibility and claims
    • Coordinate Behavioral benefits, eligibility and claims
    • Coordinate Dental, pharmacy, vision and other benefits, eligibility and claims where applicable
    • Correspondence requests
    • Educate members about the fundamentals of health care benefits including:
    • Managing health and well being
    • 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
    • Pre-authorization and pre-determination requests and status
  • Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
  • Communicate with members and their care givers regarding anticipated member service needs and resolution of issues
  • Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience.
  • Interacts with executives and senior leaders identify and/or resolve member issues including ongoing communication of issue outcome
  • Builds and maintains an elaborate list of business partners across all lines of business to escalate member inquiries on an as needed basis
  • Employees may be asked to work independently after hours to resolve urgent issues that surface after normal business hours. This role has the ability to work outside of established procedures to ensure high level member satisfaction
  • Identify gaps in processes and work closely with other departments for process improvement
  • Provide education and status on previously submitted pre-authorizations or pre-determination requests
  • Meet the performance goals established for the position in the areas of efficiency, call quality, customer satisfaction, first call resolution and attendance
  • Maximizes use of community services, support programs, and resources available to member

This is high volume, customer service environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone. Strong computer and software navigation skills are critical. You should also be strongly patient-focused and adaptable to changes.

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 higher) and 4+ years work or volunteer experience in coaching and guiding internal or external customers (customer service) OR Associate's Degree (or higher) and 2+ years work or volunteer experience in coaching and guiding internal or external customers (customer service) OR Bachelor’s Degree (or higher) and 6+ months work or volunteer experience in coaching and guiding internal or external customers (customer service)

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)
  • Customer Service Experience
  • Experience working with Medicaid

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:

  • Employees will be provided training to gain proficiency in member tools, benefit interpretation, and complex issue management to interpret situation and proactively address complex member issues.
  • Service Navigators will perform: Inbound/Outbound, RSS, some Escalation/NEC, OPW research on claims & prior authorization, interact with Optum and other internal/external resources
  • Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner and delivering on commitments)
  • Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
  • Ability to use analytical thought process to dissect complex claim issue, and complete appropriate steps to resolve identified issues/or partner with others to resolve escalated issues.
  • Ability to use critical thinking skills to negotiate complex health scenarios
  • Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
  • Ability to provide necessary feedback and identify root cause to other call center agents, departments and leaders to ensure process improvement
  • Ability to utilize multiple systems/platforms while on a call with a member – strong computer skills and technical aptitude
  • Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon. Flexibility to customize approach to meet all types of member communication styles and personalities
  • Excellent conflict management skills including professionally and adeptly resolve issues while under stress, remaining calm and composed under pressure to work through issue with difficult interactions diffuse conflict and member distress
  • Demonstrate emotional resilience
  • Consistent performance delivering excellent service to members under challenging and difficult circumstances
  • Strong verbal and written communication skills. Solid time management skills and strong attention to detail

Physical and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life’s best work.SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $17.12 to $30.34. The salary range for Connecticut / Nevada residents is $18.80 to $33.41. 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

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: customer service, call center, advocate, healthcare, benefits, UHG, UHC, CSR, health care, phone support, concierge, coaching, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO