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Job Details


UnitedHealth Group

Senior Complex Customer Service Representative - Atlanta, GA (109147866)

Customer Service

Customer Service

Yearly

No

Atlanta, Georgia, United States

$750 Sign On Bonus For External Candidates

If you are located within commutable distance to Atlanta, GA, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

Our Optum Health Care Advisor role is challenging, rewarding, and allows for individual growth and the chance to focus on a variety of skills. Are you ready to make heath care work better?

A Senior Customer Service Representative is a single point of contact for consumers for all things related to health and wellness benefits. A Health Care Advisor helps members navigate the health care system; including helping with claim and benefits questions, helping members find quality doctors and schedule appointments; connecting consumers with health and wellness resources; and coaching members to make better health choices by providing education. A Health Care Advisor creates an ongoing and lasting impression of the Optum consumer experience.

This position is full-time Monday- Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (Monday – Friday 8:00am – 11pm EST. It may be necessary, given the business need, to work occasional overtime including Saturdays . Our office is located at 2100 Riveredge Parkway, Atlanta, GA 30328.

There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application. Once you submit your completed application, you will receive an email with information regarding next steps including any pre-employment assessment(s) that are required. Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: http://uhg.hr/OurApplicationProcess

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

Primary Responsibilities:

  • Handle inbound and outbound calls with an emphasis on excellent customer service in a call center environment.
  • Take responsibility for addressing member issues, questions, concerns, and see them through to resolution.
  • Respond to members and providers in a polite and courteous manner, with patience, empathy, care, compassion, and sincerity in voice tone and pace.
  • Assist members with medical and pharmacy benefits, medical plan overview, behavioral health inquiries, claims, provider search and prior authorization.
  • Provide member education on HSA, FSA, HRA, and other financial accounts.
  • Serve as a Health Care Advisor, going above and beyond for consumers, creating a memorable consumer experience, and providing expert, proactive service to members by:
  • Finding creative ways to do more than what the member expects
  • Delighting each member by meeting their unexpressed needs
  • Leaving each person feeling confident and cared for
  • Provide services such as:
  • Education to help simplify the healthcare system and validate members understanding of next best actions
  • Advise members in choosing healthcare providers that meet and exceed consumer needs
  • Educate members on clinical and wellness resources they can take advantage of to manage a health condition/disease or reach a wellness goal
  • Provide education to members to assist in understanding benefits, terminology, claim resolution and Explanation of Benefit interpretation
  • Serve as an advocate by responding to, resolving and escalating complex claim issues with internal and external resources
  • Initiate telephone calls to internal sources, membership, providers, and other claim payers to gather data and determine resolution to claim issues
  • Refer qualified members into Wellness and clinical programs
  • Solve problems systematically, using sound business judgment, and following through on commitments
  • Consistently meet established productivity, schedule adherence, meeting metric expectations, and quality audit standards
  • Work with cross carries to ensure member follow up and resolution (cross carrier functions)
  • Work with providers and plans to help ensure critical info is being relayed timely between the plan and the provider.
  • Support multiple clients and their individual expectations.
  • Help establish patient appointments for the first time visit to the PCP.
  • Provide community resources once internal resources have been exhausted (e.g. Financial assistant programs, Medical assistant program resources)
  • Work with Network management to ensure panel request are up to date and when providers are not confirming to the contract (e.g. balance billing)

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)
  • 1+ years of experience within the Healthcare Field, Advocacy Service, Customer Service, and/or Call Center Services, Sales, Hospitality
  • 1+ years of experience with insurance, benefits, and claims
  • Proficiency with Microsoft Office - Microsoft Word (creating, editing, saving, formatting), Microsoft Excel (create and edit spreadsheets), Microsoft PowerPoint (create, edit, and format presentations) and Microsoft Outlook (compose and respond to email)
  • Ability to work a scheduled shift Monday through Friday between the hours of 8am to 11pm EST
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.

Preferred Qualifications:

  • Associate’s Degree (or higher) in related field
  • Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer applications and apply their use while on the phone
  • Experience with medical or health terminology
  • Multi-lingual proficiency (e.g. English/Spanish)
  • Inside sales

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 https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.

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: #RPO, #YELLOW

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