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UnitedHealth Group Premier Customer Service Advocate - Work From Home in Richardson, Texas

Our office is located at Richardson, TX. Employees will be required to work some days onsite and some days from home.

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

Challenge can often be its own reward. But why settle for just being challenged when you can also be nurtured, mentored and supported as you make an impact in a fast-paced career?

As a Premier Customer Service Advocate for UnitedHealthcare , you'll be responsible for building trust with members across their health care lifecycle. This function is responsible for assisting members with medical and pharmacy benefits, eligibility, claim resolution, triaging dental and vision issues, assisting with plan selection and enrollment, and improving health care literacy. This function is also responsible for multiple types of claim payment adjustments, including closed claims and denied claims. This function is expected to identify opportunities to resolve member issues timely.

This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 10:00pm CST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 1311 W PRES BUSH , RICHARDSON, TX.

*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

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) OR equivalent work experience

  • 4+ years of combined education, work and/or volunteer experience

  • 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.

Telecommuting Requirements:

  • Reside within Richardson, TX

  • 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

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

Soft Skills:

  • 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 member

  • 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

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 at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work. SM

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.

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