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. The purpose of this role is to interact with members regarding medical and pharmacy benefits, eligibility and claims issues and to assist with plan selection and enrollment. This role is expected to identify opportunities to connect members to the best resources to meet their healthcare needs and provide support in order to resolve medical and benefits issues on behalf of a member. The Bilingual Chinese Customer Service Advocate builds trust with members across their health care life cycle. Primary Responsibilities:Own problems through the resolution on behalf of the member in real time or through comprehensive and timely follow-up with the memberEffectively refers and enrolls members to appropriate internal specialists and programs, based on members' needs and eligibilityRespond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondenceResolve member service inquiries related to:Medical benefits, eligibility and claimsTerminology and plan designFinancial spending accountsPharmacy benefits, eligibility and claimsCorrespondence requestsEducate members about the fundamentals of health care benefits including:Managing health and well beingMaximizing the value of their health plan benefitsSelecting the best health plan to meet their health needsChoosing a quality care provider and appointment schedulingPremium provider education and steeragePre-authorization and pre-determination requests and statusAssist members in appointment scheduling to proactively address gaps in careIntervene with care on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance when neededResearch complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experienceOvercome objections and persuade members to take action / change behaviorUse analytical thought process to dissect complex claim issue, and complete appropriate steps to resolve identified issues / or partner with others to resolve escalated issuesProvide education and status on previously submitted pre-authorizations or pre-determination requestsMeet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendanceMaximizes use of community services, support programs, and resources available to members
Required Qualifications: High School Diploma or GEDBilingual fluency (verbal and written) in Chinese (both Cantonese and Mandarin) and English required1+ years in a Customer Service environment (proven customer service skills and experience working in retail, call centers, or any other professional setting)Upon hire you must successfully complete the UnitedHealthcare Operations CCP new hire training and demonstrated proficiency required. This role will also be required to successfully complete the UnitedHealthcare Operations Customer Service Advocate training classes and demonstrate proficiency of the materialMust be available Monday - Friday 9:00 am - 5:30pm, with the flexibility to adjust daily schedule, and work over-time and / or weekends, as neededPreferred Qualifications: Associate's Degree or higherExperience in Health Care / Insurance environment, preferred (familiar with medical terminology, health plan documents, or benefit plan design)Previous experience in translating healthcare-related jargon and complex processes into simple, step-by-step instructions customers can understand and act upon Soft Skills:Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner and delivering on commitments)Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests and identify the current and future needs of the memberAbility to utilize multiple systems / platforms while on a call with a member - strong computer skills and technical aptitudeProficient problem solving approach to quickly assess current state and formulate recommendationsFlexibility to customize approach to meet all types of member communication styles and personalitiesExcellent conflict management skills including: Professionally and adeptly resolve issues while under stress, diffuse conflict and member distress, and demonstrate personal resilienceStrong verbal and written communication skillsSolid time management skillsStrong attention to detail 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 working at a computerService center environment with moderate noise level due to phone conversation, printers, and floor activitiesCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as Cardiovascular Disease, Diabetes, HIV/AIDS and High-risk Pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive Healthcare, Community, and Government partners to heal healthcare and create positive change for those who need it most. This is the place to do your life's best work. 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: Customer Service; CSR; Bilingual; New York UnitedHealth; UHG
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.