Bilingual Member Support and Retention - Phoenix, AZ - Full-time / Part-time

Position Description:

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.

Our
Customer Service teams have a serious responsibility to make every
contact informative, productive, positive, and memorable for what it
says about how much we care.

The primary purpose of this position is three-fold:

• Onboarding:  Ensuring members understand their personal plan of care and are connected to their provider
• Outreach:  Helping
  members access the care they need, based on quality goals through
  identifying gaps in care, access and services.
• Member Support:  Providing high quality escalated member support for tough to solve issues

Those
in this role will utilize scripting, a call anatomy, and critical
thinking skills to ensure members are reminded of the tests and
treatments needed for healthier lives, understand how their benefits
support their health, connect members with providers to deliver health
care services, assist members in accessing community services to meet
basic needs, and connect members to clinical or psychosocial resources
should they need further assistance.

Primary Responsibilities:

• Work
  via an auto-dialer or manually dial members as identified by the
  Clinical Quality team to remind the member of a gap in their care
  according to evidence based medicine guidelines and assist the member
  with barriers they may have to addressing their health needs.
• Following
  a call anatomy, connect with the member to establish a trusting
  relationship and, utilizing job aids and critical thinking skills,
  assess the barriers that are prohibiting the member from seeking the
  proper care, and answer members question about benefits.
• If
  Barrier to Care is provider related the agent will assist the member
  with finding a new doctor and working with provider's office to set up
  new appointment.
• If Member is identified as having an issue meeting basic needs the agent would help connect the member to community resources.
• Responsible
  for the resolution of escalated member calls that are received by the
  call center.  This could include connecting members with community
  resources, assisting members to locate a specialist, supporting the
  intake and resolution of appeals and grievances or resolving other
  nonstandard member requests.
• When
  appropriate, agents would need to escalate members to social or
  clinical resources for members requiring more specialized support.
• Work
  offline to resolve member barriers to care requiring more research and
  follow-up with the member to help remove care barriers.
• Work
  via an auto-dialer, contact newly enrolled members as identified by the
  Business Intelligence team to welcome them to our health plans. The
  primary goal of this interaction is to develop a positive relationship
  and ensure the member has the information and documentation they need to
  have a positive experience as our member.
• Welcome
  the member to their respective health plan by verifying key information
  about the member (home address, PCP assignment, etc.) and discussing
  the benefits available through the plan.
• When
  appropriate, encourage members to appropriately utilize services in an
  effort to improve the health and well being of all members.  This might
  include education about the importance of using the ER only in true
  emergencies.
• Complete
  a Health Risk Assessment following the UnitedHealthcare national
  standard HRA as programmed into CareOne and the HRA database (when
  necessary).
• When possible, correct member information in our databases, including the member's address, PCP assignment.
• When
  possible, order replacement member materials (ID cards, welcome
  packets) if a member reports that they have not received them or if the
  member has had a change of address.
• When
  necessary, transfer the member to:  member services for advance
  benefits questions or Care management, if the member has an emergent
  physical health need or  to Optum, if the member has an emergent
  behavioral health need.  If unable to transfer the member, provide the
  member with the appropriate phone number to contact the resources they
  need for assistance.
• Document member responses and call outcomes in the auto-dialer, Access Database, or CareOne as appropriate.

Requirements:

• High School Diploma/GED or 5+ years of equivalent experience
  
• Ability to work a Full-Time schedule within the hours of 7:00 am - 7:00 pm, Monday through Friday 40 hour work week
  
• 2+ years of Customer Service experience, would prefer call center experience
  
• 2+
  years of experience in an office environment using the telephone and
  computer as the primary instruments to perform the job duties.
• Bilingual fluency in English and Spanish.

Assets:

• Electronic Medical Records experience

Physical Requirements and Work Environment:

• Frequent
  speaking, listening using a headset, sitting, use of hands/fingers
  across keyboard or mouse, handling other objects, long periods of close
  vision looking at a computer monitor
• Service center environment with moderate noise level due to Representatives talking, computers, printers, floor activity

Diversity
creates a healthier atmosphere: 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.