If you are located within Eastern and Central Time Zones, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Our Optum Health Care Advisor role is challenging, rewarding, and allows for individual growth and the chance to focus on a variety of skills. Are you ready to make heath care work better?

A Senior Complex Customer Care Representative is a single point of contact for consumers for all things related to health and wellness benefits. A Health Care Advisor helps members navigate the health care system; including helping with claim and benefits questions, helping members find quality doctors and schedule appointments; connecting consumers with health and wellness resources; and coaching members to make better health choices by providing education. A Health Care Advisor creates an ongoing and lasting impression of the Optum consumer experience.

There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application. Once you submit your completed application, you will receive an email with information regarding next steps including any pre-employment assessment(s) that are required. Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: Our Hiring Process - UHG (unitedhealthgroup.com)

This position is full-time Monday- Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours from 8:00am – 11:00pm EST. It may be necessary, given the business need, to work occasional overtime including Saturdays.

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  All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

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  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.
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  Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans
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  Contact care providers (doctor’s offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance.
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  Be a single point of contact for highly designated, dedicated UHC national or key account insurance plans.
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  Identify the areas of assistance and offer resolution for benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx Pharmacy, Optum Behavioral Health and self-service options
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  Educate members about the fundamentals and benefits of managing their health and well-being
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  Assist in navigating UnitedHealth Group websites or applications utilizing remote desktop system capabilities
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  Construct communication via secure messaging, e-mail or chat
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  Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.
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  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.
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  Meet the performance goals established for the position in the following areas: effectiveness, efficiency, call quality, member satisfaction, first call resolution, and adherence

Additional Responsibilities:

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  Performs claims adjustments/dollar payments to providers and/or members ultimately impacting UHC costs or commercial account costs
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  Effectively refer and enroll members to appropriate internal specialists and programs, based on member’s needs and eligibility using multiple databases
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  Must remain current on all communicated changes in process and policies / guidelines.
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  Adapt to all process changes quickly, and maintain knowledge of changes at site level and entity level by utilizing all available resources
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  Maximize use of community services, support programs, and resources available to 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:

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  High School Diploma / GED (or higher) OR equivalent work experience
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  Minimum of 4+ years of combined education, work and/or volunteer experience
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  2+ years of call center/customer service experience in a professional environment
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  Ability to report onsite first day of training
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  Ability to work any shift between the hours of 8:00am - 11:00pm EST including the flexibility to work occasional weekend (Saturdays) overtime based on business need

Preferred Qualifications:

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  Health Care/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design
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  Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)
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  Prior claims processing experience with simple and complex adjustments.
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  Sales or account management experience

Telecommuting Requirements:

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  Reside within Eastern and Central Time Zones
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  Required to have a dedicated work area established that is separated from other living areas and provides information privacy
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  Ability to keep all company sensitive documents secure (if applicable)
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  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:

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  Exceptional written and oral communication skills adaptable to live phone conversations as well as e-mail or chat exchanges that drive a trusted relationship
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  Propensity to quickly build rapport and respond to members with courtesy and with a sense of urgency
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  Talent to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the member
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  Proficient problem-solving techniques to quickly assess current state and formulate recommendations
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  Excellent conflict management skills
  
• Professionally and adeptly resolve issues under pressure
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  Diffuse conflict and exhibit compassion for distressed members
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  Demonstrate personal resilience
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  Ability to utilize and navigate multiple systems/platforms
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  Strong attention to detail
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  Adjustability to environmental change
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  Work collaboratively with internal and external partners to achieve enterprise goals
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  Model UnitedHealth Group's Principles of Integrity, Core Values and Compliance
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  Maintain the confidentiality of sensitive information
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  Strong computer skills and technical aptitude

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

Connecticut, New York or Rhode Island Residents Only: The salary range for Connecticut / New York / Rhode Island residents is $18.80 - $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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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