Senior Complex Customer Care Representative - National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The role of a Senior Complex Customer Care Representative is challenging and rewarding, offering opportunities for individual growth and the development of a variety of skills. The focus is on putting members at the center of everything we do, streamlining their experience and maximizing available resources for their personal health journey.

As a Senior Complex Customer Care Representative, you will build relationships with individuals and their families, guiding them in navigating and advocating for their benefits, claims, and access to care. This includes understanding and educating consumers on the lifecycle of a claim and prior authorization, thorough explanation of the mechanics of the benefit plan and access to provider networks and connecting the consumer to resources for social determinants of health (SDoH) issues such as transportation, access to food, housing, and financial concerns. You will deliver a best in class, consultive member experience across all health and wellbeing carriers, benefits, programs, and plans, including medical, behavioral, pharmacy, financial, specialty, and ancillary benefits, creating a more connected experience.
Optum Guide is not a standard customer service model. As a Senior Complex Customer Care Representative, you will act as a healthcare navigator, utilizing assertive sales and probing question techniques to understand why the consumer is activating their health insurance plan, accurately guiding them through the experience of using their plan, anticipating needs to proactively ensure they can have confidence in accessing their healthcare plan. You will own all member concerns that require additional research by coordinating resolution with third parties, including providers and vendors. Optum Guide is a premier product that our clients purchase with the goal of providing holistic, consumer-driven support using carefully crafted systems and resources.

In this role, you must be comfortable working in a metric-based environment where performance is monitored daily. We measure value across various areas, including member satisfaction, member support, and digital experience. As a Senior Complex Customer Care Representative, you will provide support to up to but not limited to 10 clients.

If you are ready to make healthcare work better and are interested in a role that combines advocacy, navigation, and relationship-building, the Senior Complex Customer Care Representative position may be a great fit for you.

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: Our Hiring Process - UHG (unitedhealthgroup.com)

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 8:00 am - 11:00 pm EST. It may be necessary, given the business need, to work occasional overtime including Saturdays.

We offer 8 weeks of paid training. The hours during training will be 9:00 am - 5:30 pm CST, Monday - Friday. Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Build and maintain strong relationships to provide 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, emails and chats 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
• Demonstrate expertise in claims processing and interpretation, resolving any claim-related issues or discrepancies in a timely and efficient manner
• Identify the areas of assistance and offer resolution for benefits, eligibility, claims, financial spending accounts, correspondence, pharmacy, 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

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 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 equivalent work experience
• Must be 18 years of age OR older
• 2+ years of high demand contact center and / OR customer service experience in a professional environment
• 1+ years of experience within the Healthcare Field, Advocacy Service, Customer Service, and / OR Call Center Services, Sales, and Hospitality
• De-escalation experience, including the ability to ensure consumers feel heard and cared for in every interaction
• 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
• Proficiency with Microsoft Office including Microsoft Excel, Microsoft Word, Microsoft Outlook, and Microsoft PowerPoint
• Ability to work Monday - Friday, in any of our 8-hour shift schedules during our normal business hours of 8:00 am - 11:00 pm EST, including the flexibility to work occasional overtime and Saturdays, based on the business need

Preferred Qualifications:

• Experience with medical OR health terminology
• Sales experience, including a demonstrated ability to influence consumer behavior toward highest value outcomes
• Multi-lingual proficiency (e.g., English and Spanish)

Telecommuting Requirements:

• 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:

• Resilience and resourcefulness that deliver a best-in-class experience to solve complex health care problems for our consumers
• Utilize assertive soft skills to proactively identify and address members' needs, ensuring a personalized and comprehensive approach
• Ability to understand and effectively explain complex benefit plans
• Ability to overcome objections and persuade members to take action / change behavior
• Ability to use multiple systems while assisting consumers
• Flexibility to customize approach to meet all types of member communication styles and personalities
• Quality focused
• Customer service, interpersonal, communication, and organizational skills
• Interpersonal, written and verbal communication skills
• Problem solving and critical thinking skills to resolve complex healthcare issues
• Attention to detail
• Conflict management skills including:
  
  
  
  
  • Ability to resolve issues under stress
  • Diffuse conflict and member distress
  
  
  
  

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy