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Positions in this function are responsible for providing expertise and customer service support to members as part of our UnitedHealthcare Advocate4Me model. Direct phone-based customer interaction to address complex member needs and provide recommendations on services that may help close gaps in care for the member and / or the member's family. May authorizes claims payments or refer claims to investigators for further review.
Own problems through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
Effectively refers and enrolls members to appropriate internal specialists and programs, based on member's needs and eligibility
Respond to and resolve on the first call, customer 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
Resolve member service inquiries related to:
Medical benefits, eligibility and claims
Terminology and plan design
Financial spending accounts
Pharmacy benefits, eligibility and claims
Educate members about the fundamentals of health care benefits including:
Managing health and well being
Maximizing the value of their health plan benefits
Choosing a quality care provider and appointment scheduling
Assist members in appointment scheduling to proactively address gaps in care
Intervene with care on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when needed
Research complex issues across multiple databases and work with support resources to resolve customer issues and / or partner with others to resolve escalated issues
Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
Maximizes use of community services, support programs, and resources available to member
Extensive work experience within own function
Work is frequently completed without established procedures
May act as a resource for others
May coordinate others' activities
Proficient problem-solving approach to quickly assess current state and formulate recommendations
Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrating personal resilience
High School Diploma / GED
Bilingual fluency in English and Korean (speak, read, and write)
Ability to work regularly scheduled shifts within our hours of operation including the training period
1+ years of prior experience in an office setting, call center setting, or phone support role
Experience with Microsoft Word (creating and editing) and Microsoft Excel (creating and editing)
Bachelors Degree (or higher)
Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner, consistently meeting commitments)
Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
Flexibility to customize approach to meet all types of member communication styles and personalities
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 lifes best work.
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: customer service representative, customer service, CSR, UnitedHealth Group, call center, UnitedHealthcare, health care, office, phone support, training class, Korean, bilingual