Advocate
: Job Details :

If you are within 60 miles of San Antonio, TX, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges. 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 The role of the Elite Super Advocate will be responsible for coaching and supporting the San Antonio Elite customer service advocates. The Elite Super Advocate's will 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 7:00am – 9:00pm CST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 6200 Northwest Pkwy, San Antonio, TX 78249. Employees will be required to work some days onsite and some days from home. We offer 2 weeks of component training. The hours of the training will be based on schedule or will be discussed on your first day of employment. *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary Responsibilities: Provide premium or elite level, proactive support and service with end-to-end resolution for members, using their preferred communication method. Resolve escalated and complex calls/claim adjustments/issues from members that front line advocates are unable to resolve or need assistance on, working directly with business partners to make decisions regarding claim reconsiderations, prior authorizations, and appeal considerations. Engage in real time collaboration with appropriate clinical partners to resolve member concerns, connecting them with clinical programs and resources as needed. Act as a Subject Matter Expert (SME) for benefits and claims (Call & Digital) to provide real time guidance to advocates who may need help to resolve a member issue. Act as the primary contact for Service Account Managers. Provide support, coaching, technical training and feedback to other advocates regarding best practices. Work with supervisors to suggest or identify training or resource needs to enhance performance and manage ORS inventory at the team/client level. Identify gaps in process, work with business partners to determine new processes, write/communicate process changes. Own relationships and interactions with chronic issues or complex client micro populations such as Special Needs or Transgender members providing end to end resolution for members, using their preferred communication method. Facilitate proactive outbound calls when necessary to educate members on the best use of the benefits, to welcome new members to UHC, etc.; owning the close-loop process. 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, proactive member engagement with clinical referrals, lower cost Rx alternatives, portal promotion, provider steerage to in-network providers, efficiency and attendance. Support escalated members and staff when a member asks to speak to a supervisor or the front-line advocate needs assistance in de-escalating an upset member. Perform all job functions required as an Elite or Premier Advocate. Complete outbound calls to close the loop with members who express dissatisfaction with issue resolution or service via the post call survey after speaking to an advocate. Work with partners including medical, clinical, financial, behavioral and Rx to resolve issues as needed. Maximize use of community services, support programs and resources available to the 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 experience in a customer service related environment. 1+ years of consumer services experience as an E&I Advocate4Me. Ability to complete E&I Ops Tier 2 Training. Must be meeting minimum performance requirements within existing role. Ability to work Monday - Friday an 8 - hour shift between the hours of 7:00am - 9:00pm Central Time. Preferred Qualifications: Experience in Health Care / Insurance environment (Familiarity with medical terminology, health plan documents, or benefit plan design). Telecommuting Requirements: Reside within commutable distance of San Antonio, TX. 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. 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. #RPO