Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM
Positions in this function are responsible for first-level response and resolution or triage of escalated issues with external and internal customers. Responsible for the overall delivery of benefits and services by providing on-site support and guidance to assigned client (s) (may include one or more accounts). Acts as outward-facing, dedicated resource for assigned account, with direct client contact for large or complex client. Builds relationships with employer/group client (not individual members) and serves as the primary point of contact for day-to-day operational service delivery. Represents client internally and coordinates with other functions to infuse call / claim service delivery expectations, complete projects, and address ongoing service needs.
- Investigate and manage escalated claim/call/appeals issues through root cause analysis and communicate outcome (in person, telephonically or via written communication) to internal partners or external clients.
- Serve as liaison between internal customers and external customers to facilitate call and claim issue resolution and respond to inquiries.
- Simplify and personalize interactions with consumers and clients to align with evolving service/quality expectations and single point of contact demands. (Deliver simply great service)
- Track, trend and proactively review accounts for service opportunities.
- Drive process improvement based on trend analysis.
- Identify and report system problems in relation with benefit installation and interpretation.
- Complete adhoc report requests and analysis.
- Document and track all issues and activities accurately within ETS-BE.
- Complete and deliver complex Performance Guarantee reporting to internal and/or external customers.
- Create and deliver quarterly and annual service performance scorecards.
- Create and deliver to Operations Account Manager quarterly 4-Block with overall client experience results.
- Represent UHC operations in communication to clients related to new programs and enhancements to existing programs.
- Proactively messaging to clients and Account Management Team.
- Drive excellence in service within organization and across organization by providing feedback to Operations on service failures.
- Attend Account Management and/or client meetings representing call and claim and host and/or lead internal meetings with operations leaders to share Voice of the Customer feedback.
- Lead service remediation efforts by creating action plan, hosting meetings with internal and external partners, sharing updates with UHC leaders and driving solution to resolution.
- Provide consultative support to strategic business partners, assisting in delivery of services for new/existing business implementation, i.e., engaging in conversations regarding past experience or potential issues around benefit or claim processing.
- Develop and deliver customer specific (benefit, claim, and cultural) training to Transaction and Customer Care organization.
- Support and/or host existing customer site visits.
- Lead process improvement special projects and work teams for dedicated client and potential global impact.
- Support in external customer audits e.g. operational assessment, audit recommendation responses, hosting audit meeting.
- Support Open Enrollment (i.e. updating open enrollment tools, training call teams, benefit fairs, vendor summits etc.)
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.
- High School Diploma / GED (or higher)
- 2+ years of experience as Service Account Manager or related experience.
- 1+ year of experience in operational processes (i.e. call, claim, appeals etc.)
- 2+ years of experience with operational systems (UNET, CAMs, ISET, A4Me, UES, Behavioral Analytics, Adhoc reporting, etc.)
- Strong knowledge of medical terminology, referral and authorization practices, standard-coding methodologies (CPT, ICD-10, HCPCS and revenue) and Health Care Reform requirements.
- Strong knowledge of the health insurance industry, products and service and the managed care environment.
- Expert personal computer skills including word processing, database management and spreadsheet applications including PowerPoint (copy, create, type, and create presentations), Excel (data entry, create spreadsheets) and Word (copy, paste, type)
- Travel for client or internal 25%.
- Bachelor's Degree(or higher)
- UNET claims platform experience
- Superior organizational skills and attention to detail.
- Superior oral, written and presentation skills.
- Proven customer service/relationship building skills and stablish and maintain effective relationship with assigned client.
- Strong analytical/problem solving skills.
- Handle multiple tasks in a fast-paced environment.
- Professional and polished.
- Work independently.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do 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.
Keywords: Claims, Appeals, Supervisor, Account, Manager, Service, UHG