This role is temporarily remote. Training is conducted virtually from your home. This role is a remote role and once training is completed, you might transition to work in the office in the future

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

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 - Friday. Overtime may be required. Employees are required to have flexibility to work business hours of 9:30am – 6:00pm EST. Our office is located at 2100 River Edge Parkway, Atlanta, GA 30328.

We offer up to 30 weeks of paid training (this is inclusive of on-the-job training, phone calls, and class room facilitation). The hours during training will be 930 - 6pm EST Monday – Friday. Training will be conducted in a classroom setting. The first week of training will be onsite in the office and the rest of time will be virtual (Camera is expected to be on).

*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.
• Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans
• Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance.
• Be a single point of contact for highly designated, dedicated UHC national or key account insurance plans.
• Identify the areas of assistance and offer resolution for benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx Pharmacy, Optum Behavioral Health and self-service options
• Educate members about the fundamentals and benefits of managing their health and well-being
• Assist in navigating UnitedHealth Group websites or applications utilizing remote desktop system capabilities
• Construct communication via 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.
• 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.
• Meet the performance goals established for the position in the following areas: effectiveness, efficiency, call quality, member satisfaction, first call resolution, and adherence
• Professionally and adeptly resolve issues under pressure
• Diffuse conflict and exhibit compassion for distressed members
• Ability to utilize and navigate multiple systems/platforms
• Strong computer skills and technical aptitude

Additional Responsibilities:

• 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
• 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
• 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 and provide 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
• Minimum of 4+ years of combined education, work and/or volunteer experience
• 2+ years of call center/customer service experience over the phone in a professional environment
• Ability to travel up to 25%
• Ability to report onsite first week of training
• Experience with computer and Windows PC applications (e.g., Word, Excel, Power Point), which includes the ability to learn new complex computer system applications and programs
• Ability to work full-time Monday - Friday. Overtime may be required. Employees are required to work normal business hours of 9:30am - 6:00pm EST.

Preferred Qualifications:

• Sales or account management experience
• Prior claims processing experience with simple and complex adjustments.
• 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)

Telecommuting Requirements:

• Reside within 50 miles of Office Location our office which is located at 2100 River Edge Parkway, Atlanta, GA 30328.
• 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

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.

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