1+ months

Elite Advocate - Atlanta, GA

Atlanta, GA 30303
  • Job Code
    835463

Challenge can often be it's 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 an Elite 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.


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
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Categories

Posted: 2019-06-26 Expires: 2019-09-27

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Elite Advocate - Atlanta, GA

UnitedHealth Group
Atlanta, GA 30303

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