If you are located within Charleston, WV, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.
UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.
In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.
Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.
As a Plan Advisor for UMR you’ll have the opportunity to make a difference in the lives of our members and their families each day as they look to you as their trusted advisor and advocate. You’ll be empowered to compassionately deliver an exceptional experience - always remembering that there is a real person on the other end of the phone who is looking for help, guidance, and support. You’ll help them understand and make informed decisions about their care services by assisting them with their needs from start to finish. You will answer their questions, and may resolve outstanding issues, schedule appointments, or help them to enroll in and/or select a health care plan.
The Plan Advisor Representative handles up to 50-70 calls per shift, always remembering to bring compassion and a sense of engagement to enhance the customer experience. In between calls/ during offline time, Plan Advisor Representatives will process medical claims (following successful completion of claims training). A good understanding of medical benefits and medical terminology to assist with processing claims (once trained) is key. The role follows a daily schedule. Key Performance Metrics: units per hour, call and claim handling, attendance, etc. 80% calls/ 20% claims
This position will receive provider calls up to 50-70 calls daily and requires full attention to work duties. Employees in this role must be able to ensure they will have uninterrupted work time while they are on shift (outside of normally scheduled breaks and lunch).
The 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 7:00 AM - 7:00 PM EST. It may be necessary, given the business need, to work occasional overtime.
We offer up to 10 weeks of paid training (depending on business needs). The hours during training will be 9:00 am - 5:30 PM EST from Monday – Friday (subject to trainer availability). 100% attendance during training is mandatory. Training will be conducted virtually from your home.
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Primary Responsibilities:
- Provide an exceptional customer service experience when responding to and resolving 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
- Research complex issues (such as Medical, Dental, Flex Spending, Pharmacy, etc.) across multiple databases and work with support resources to resolve customer issues and/or partner with others to resolve escalated issues
- Own issue through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
- Apply creative solutions and effective problem-solving techniques to address members’ needs
- Educate the member on health incentives offered by their employer as well as consumer driven health products; HSA, HRA, and HDHP - some resulting in additional healthcare dollars for the member to utilize
- Educate the caller on the benefits of a primary care physician and help to ensure/educate that all preventive screenings have been completed
- Intervene with care providers (doctor’s offices) on behalf of the member to assist with appointment scheduling or other matters when needed
- Address complex issues with an awareness of when to refer complicated situations to various departments or leadership for further assistance
- Translate healthcare-related terms or terminology and complex processes into simple, step-by-step instructions which members can understand
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 10+ years of equivalent work experience
- Must be 18 years of age or older
- 1+ years of customer service experience in an office or professional setting
- Ability to successfully complete the training classes and demonstrate proficiency of the material
- Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm EST. It may be necessary, given the business need, to work occasional overtime
- This position will receive provider calls up to 50-70 calls daily and requires full attention to work duties. Employees in this role must be able to ensure they will have uninterrupted work time while they are on shift (outside of normally scheduled breaks and lunch).
Preferred Qualifications:
- Familiarity with medical or dental terminology, health plan documents, OR benefit plan design
- Prior experience with utilizing multiple systems / platforms while on a call with a member
Telecommuting Requirements:
- Must reside within the state of West Virginia
- 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.
Soft Skills:
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
- Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a 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
- Proficient problem-solving approach to quickly assess current state and formulate recommendations
- Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrate personal resilience
- Ability to multi - task as well as the ability to understand multiple products and multiple levels of benefits within each product
- Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule and work over - time as needed
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.
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