Customer Service Representative - Henderson, NV

Company: UnitedHealth Group
Location: Las Vegas
Posted on: January 15, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)Positions in this family have the primary responsibility of providing telephonic customer service.Positions in this function are responsible for providing expertise and customer service support to members, customers, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries.Primary Responsibilities: -

• Applies knowledge/skills to activities that often vary from day to day
• Demonstrates a moderate level of knowledge and skills in own function
• Requires little assistance with standard and non-standard requests
• Solves routine problems on own
• Works with supervisor to solve more complex problems
• Prioritizes and organizes own work to meet agreed upon deadlines
• Works with others as part of a team
• Moderate work experience within own function
• Some work is completed without established procedures
• Basic tasks are completed without review by others
• Supervision/guidance is required for higher level tasks -Functional Competencies:
  • Provide Phone Support to Drive Resolution of Caller Questions/Issues
    • Demonstrate understanding of internal/external factors that may drive caller questions/issues (e.g., recent plan changes, mass mailings, call directing/rerouting, weather emergencies)
    • Ask appropriate questions and listen actively to identify underlying questions/issues (e.g., root cause analysis)
    • Gather appropriate data/information and perform initial investigation to determine scope and depth of question/issue
    • Identify and coordinate internal resources across multiple departments to address client situations, and escalate to appropriate resources as needed
    • Proactively contact external resources as needed to address caller questions/issues (e.g., providers, labs, brokers)
    • Utilize appropriate knowledge resources to drive resolution of applicable questions/issues (e.g., websites, CRM tools, Onyx, Siebel, knowledge bases, product manuals, SharePoint)
    • Identify and communicate steps/solutions to caller questions/issues, using appropriate problem-solving skills and established guidelines, where available (e.g., workarounds, descriptions of relevant processes)
    • Offer additional options to provide solutions/positive outcomes for callers (e.g., online access to relevant information, additional plan benefits, workarounds for prescription delays)
    • Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, brokers, pharmacies)
    • Drive resolution of caller questions/issues on the first call whenever possible (e.g., first-call resolution, one-and-done)
    • Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution)
    • Develop and Maintain Productive Relationships/Interactions with Callers
      • Manage caller conversations appropriately (e.g., provide a good first impression, command attention and respect, maintain professional tone, demonstrate confidence, de-escalate/defuse callers as needed)
      • Apply knowledge of applicable Service Level Agreements (SLAs) and Performance Guarantees when interacting with callers
      • Maintain ongoing communications with callers during the resolution process to communicate status updates and other required information
      • Maintain focus on caller interactions without being distracted by other factors (e.g., system usage, pop-up alerts, VCC data)
      • Acknowledge and demonstrate empathy/sympathy with callers' life events (e.g., wedding, birth of baby, loss of relative, recent illness)
      • Demonstrate Business/Industry Knowledge
        • Demonstrate knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision)
        • Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, COBRA, FSA, HRA)
        • Obtain and apply knowledge of benefit structures/designs for contracted or acquired companies
        • Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements)
        • Maintain knowledge of information/process changes due to healthcare reform, referring to applicable company resources (e.g., dependent age, removal of lifetime limits, free preventive care services, Medical Loss Ratio)
        • Demonstrate knowledge of established workflows and support processes (e.g., available resources, internal/external business partners, points of contact)
        • Demonstrate knowledge of relevant internal processes impacting caller issues (e.g., claims processing, auto-adjudication)
        • Identify inaccurate/inconsistent information found in systems/tools, and communicate to appropriate resources (e.g., IBAAG, SOP, AYS, SPDs, policies/procedures)
        • Provide Consulting/Education on Caller Issues/Trends
          • Communicate common problems/questions presented by callers to appropriate Subjects Matter Experts, to drive continuous improvement
          • Educate callers on available products/services (e.g., features, functionality, options, additional offerings, preventive services, agerelated services)
          • Educate callers on self service resources available to them, and on their responsibilities with regard to their health care coverage
          • Refer callers to other resources applicable to their questions/issues, where appropriate (e.g., pharmacists, prior authorizations, billing department)
          • Review/analyze phone support data/metrics and communicate patterns/trends to internal stakeholders, as needed (e.g., leadership, Subject Matter Experts, business partners)
          • Provide training/mentoring to other team members, as needed (e.g., new-hires, refresher training)
          • Participate in customer site visits, as needed (e.g., to obtain feedback, provide education, clarify support processes, highlight company performance) - Value Based Competencies:
            • Integrity Value: Act Ethically
              • Comply with Applicable Laws, Regulations and Policies
              • Demonstrate Integrity
              • Compassion Value: Focus on Customers
                • Identify and Exceed Customer Expectations
                • Improve the Customer Experience
                • Relationships Value: Act as a Team Player
                • Collaborate with Others
                • Demonstrate Diversity Awareness
                • Learn and Develop
                • Relationships Value: Communicate Effectively
                  • Influence Others
                  • Listen Actively
                  • Speak and Write Clearly
                  • Innovation Value: Support Change and Innovation
                    • Contribute Innovative Ideas
                    • Work Effectively in a Changing Environment
                    • Performance Value: Make Fact-Based Decisions
                      • Apply Business Knowledge
                      • Use Sound Judgement
                      • Performance Value: Deliver Quality Results
                        • Drive for Results
                        • Manage Time Effectively
                        • Produce High-Quality Work - 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 education or equivalent experience
                          • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance -To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.Nevada Residents Only: The hourly range for Nevada residents is $15.00 to $24.13. 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.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.Job Keywords: Phone Support, Customer Service Representative, CSR, Customer Service Specialist, Customer Advocate, Customer Service Associate, Customer Service Agent, Call Center Specialist, Call Center Agent, Client Service Representative, Customer Care Representative, Contact Center Representative, BPO, Business Process Outsourcing, Henderson, NV, Nevada

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