The purpose of this role is to interact with members regarding medical and pharmacy benefits, eligibility & claims issues and to assist with plan selection and enrollment. This role is expected to identify opportunities to connect members to the best resources to meet their healthcare needs and provide support in order to resolve medical and benefits issues on behalf of a member. The Service Account Manager Associate builds trust with members across their health care lifecycle.
- Provide in language service to Chinese and English speaking customers over the phone
- Own problem 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 members needs and eligibility
- Respond to and resolve on the first walk - in, customer service inquires and issues by identifying the topic and type of assistance the customer needs such as benefits, eligibility and claims, financial spending accounts and correspondence.
- Resolve member service inquiries related to:
- Terminology and plan design
- Financial spending accounts
- Pharmacy benefits, eligibility and claims
- Correspondence requests and Medical 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
- 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
- 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
own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience
- Overcome objections and persuade members to take action / change behavior
- Use analytical thought process to dissect complex claim issue, and complete appropriate steps to resolve identified issues/or partner with others to resolve escalated issues.
- Provide education and status on previously submitted pre-authorizations or pre-determination requests
- 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 social services, support programs, and resources available to members by outreaching to CBOs
- Make outbound calls for various events organized by the team for higher event participation, successful member onboarding
- Bachelors degree preferred
- Experience in Health Care/Insurance environment, preferred (Familiarity with medical terminology, health plan documents, or benefit plan design)
- Previous experience in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon
Physical Requirements and Work Environment:
Helping create positive customer experiences for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life's best work.SM
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 health care. 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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