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Hours Full-time, Part-time
Location Costa Mesa, CA
Costa Mesa, California

About this job


Position Description:


Energize your career with one of Healthcare’s fastest growing
companies.  

 

You dream of a great career with a great company - where you can
make an impact and help people.  We dream of giving you the opportunity to
do just this.  And with the incredible growth of our business, it’s a
dream that definitely can come true. Already one of the world’s leading
Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to
operate our Service Centers, improve our Service levels and help people lead
healthier lives. We live for the opportunity to make a difference and right
now, we are living it up.

 

This opportunity is with one of our most exciting business areas:
Optum - a growing part of our family of companies that make UnitedHealth Group
a Fortune 14 leader.

 

Optum helps nearly 60 million Americans live their lives to the
fullest by educating them about their symptoms, conditions, and treatments;
helping them to navigate the system, finance their Healthcare needs, and stay
on track with their Health goals. No other business touches so many lives in
such a positive way. And we do it all with every action focused on our shared
values of Integrity, Compassion, Relationships, Innovation, and Performance.

 Primary Responsibilities:


Meets with Sales and Client Implementation Lead to understand client commitments in regards to operational delivery.

Reviews new client documents such as the Request for Proposal, Master Contract and Performance Guarantees to identify Customer Service Requirements.

Identifies Performance Guarantees and requirements that will impact operational delivery targets for new clients. If necessary modifies operations processes and or performance measurement process/metrics.

Creates implementation project plan for individual client as assigned.  Defines key milestones and deliverables; builds out the customer service operational readiness plan (key issues, risks, mitigation plan).

Identifies all stakeholders needing communication regarding new clients.  Develops and delivers communication.  Communicates all client requirements to Operations, Training, Telecom and Workforce leads.

Works with Workforce Management Lead to determine FTE impacts based on new client population and call volume forecast. Determines incremental staff needed by role and reviews FTE impact with VP of Operations for approval.

Partners with call center site leadership to identify location of staff.  Collaborates with Operations to determine the staffing approach if incremental staff is needed (new hires versus existing staff).

Performs gap analysis to compare current operations design to new client expectations/commitments.  Identifies updates or additions to job aids, processes, and training content.  Obtains sign off on process changes and posts approved content to appropriate tool such as myRxAdvisor (department knowledgebase tool).

Reviews existing Quality Scorecard to determine if updates are needed.  Works with Quality team to update audit tool.  Communicates new/changed quality expectations to Quality team and to Supervisors and agents. Example – use “prescription drug list” and not “formulary,” use “brand” and “generic” and not copay tier. Use “warm transfer” and not cold transfer.  Posts revised Scorecard to myRxAdvisor.

Performs gap analysis to compare current training curriculum/agenda to new client expectations/commitments.  Coordinates updates with Training Lead.

Creates Account Information document for new client (template). Uploads Account Information document into myRxAdvisor.

Determines if a training update is needed - notification of new client, new or revised process.  Identifies staff to train by role and by site.  Builds the training plan and schedule with the Training Delivery Lead.

Determines client requirements for Customer Service Toll Free No. (TFN) - Custom greetings, international calls and Spanish language support.  Creates Telecom work intake for toll free number, skilling, and Node.  Communicates all Telecom information to Operations and Workforce Leads (TFN, Skill, Node).  Participates in pre-Go-Live Telecom testing.

Determines that Workforce Lead has skilled and scheduled agents for go-live.

Determines client reporting requirements and creates Reporting work intake.

Executes a launch readiness checklist – staff, job aids, Telecom, Technology.

Participates and or facilitates post deployment checkpoints

Build, manage and maintain relationships with Operational peers

Attend Client Meetings

Identify and report system problems in relation with benefit installation and interpretation clarifications.

Investigate and manage implementation issues through root cause analysis and communicate outcome (telephonically or written) to internal partners and external clients.

Drive process improvement based on trend analysis/lessons learned from monthly implementations.

Drive process improvement with Client Management and audit remediation team

Host and/or lead client site visits and travel to meet with new or existing clients as needed.

Requirements


Required Qualifications:


High School Diploma or GED

2+ years of customer service experience

1+ year of experience in OptumRX operations with demonstrated expertise of IRIS, RXHD/Navigator, MyRXAdvisor, and/or RX Claims systems

Experience using Microsoft Word, PowerPoint, and Excel to create project plans, communications, client documents, presentations, tracking and reporting

Knowledge of pharmacy terminology

Working hours Monday through Friday 7:00 am - 6:00 pm, will need to work weekends, overtime and holidays as needed (First quarter is usually overtime)
Preferred Qualifications:


Implementation experience
Soft Skills:


Strong organizational skills and attention to detail

Serious team player

Extremely meticulous

OptumRx is
an empowering place for people with the flexibility to help create change.
Innovation is part of the job description. And passion for improving the lives
of our customers is a motivating factor in everything we do.

 

If you're ready to talk about groundbreaking
interactions, let's talk about what happens when a firm that touches millions
of lives decides to gather results from millions of prescriptions every month
and analyze their impact. Let's talk about smart, motivated teams. Let's talk
about more effective and affordable healthcare solutions. This is caring. This
is great chemistry. This is the way to make a difference. We're doing all this,
and more, through a greater dedication to our shared values of integrity,
compassion, relationships, innovation and performance.  Join us and start doing your life’s best work.SMDiversity 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: customer service claims, RxHD, IRIS, enrollment, benefits, healthcare, Optum