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Job Details


UnitedHealth Group

Premiere Super Advocate - Atlanta, GA

Healthcare

All

Full Time

On Site

No

Atlanta, Georgia, United States

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

The role of the Premier Super Advocate is to support and handle complex member scenarios as well as follow and support members with more complex and / or chronic medical conditions requiring higher system utilization by identification through contacts with the call center. The Super - Advocate’s responsibility is to provide resolution for escalated and repeat calls and focus on members who are / have the potential for higher system utilization in order to provide evidence-based support and services.

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 8:00am – 8:00pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at Atlanta, GA.

Primary Responsibilities:

  • Resolves escalated complex and repeat calls from members and works directly with business partners (complex claim reconsiderations, notifications, appeal considerations)
  • Adjudicates complex claims
  • Monitors and provides proactive support to members with more chronic member issues
  • Works with partners including medical, clinical, financial, behavioral and Rx to resolve issues
  • Engages in real time collaboration with clinical partners including, Medical Director, CM / DM Nurses in resolving member concerns and engaging appropriate clinical programs and resources
  • Answers agent questions, assist them with resolution as Subject Matter Expert and Coach
  • Writes / Communicates Process changes
  • Provides coaching as needed
  • Works with supervisors on enhancing performance
  • 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
  • Provides single point of contact for the member
  • Supports member contact through multiple channels (incoming call, chat, secure messaging, proactive outbound)
  • Responds 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
  • Owns problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member
  • Educates 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 maximizes the value of their health plan benefits
  • Advocates and intervenes with care providers (doctor’s offices) on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations
  • Assists the member with resolution as their advocate with 3rd party vendors
  • Assists members in navigating [Register to View] and other UnitedHealth Group websites or applications utilizing remote desktop system capabilities
  • Communicates and keeps consumer informed through the means in which they prefer, i.e. Phone Call, e - mail, etc
  • Researches complex issues across multiple databases and work with support resources to resolve member issues and / or partner with others to resolve escalated issues
  • Meets the performance goals established for the position in the areas of: conversation effectiveness, call quality, member satisfaction, first call resolution, efficiency and attendance
  • Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans
  • Effectively refers and enrolls members to appropriate internal specialists and programs, based on member’s needs and eligibility using multiple databases
  • Interprets and translates clinical / medical terminology into simple - to - understand terms for members
  • Responds to and resolves 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
  • Navigates 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
  • Resolves member service inquiries related to: Medical benefits, eligibility and claims, Terminology and plan design, Financial spending accounts, Pharmacy benefits, eligibility and claims, Correspondence requests
  • Educates 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)
  • Works directly with site leadership to remove process barriers
  • Navigates multiple online resource materials and follow defined process for issue handling
  • Maximizes 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
  • Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 8:00pm.
  • 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:

  • 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
  • Previous Coaching Experience

Soft skills:

  • Exceptional written and verbal communication skills adaptable to both live phone conversations as well as e - mail or chat exchanges that drive a trusted relationship based on ownership reducing customer effort

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 [Register to View]

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

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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