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. Turn on the news on any night of the week and you're likely to hear about the changes that are sweeping through our health care system. It's dramatic. It's positive. And it's being led by companies like UnitedHealth Group. Now, you can take advantage of some of the best resources and tools in the world to help serve our members. You'll play a leadership role in a high volume, focused and performance driven call center where the goal is always to connect with members and enhance the customer experience. This is no small opportunity.State of RI Executive Office of Health and Humans Services (EOHHS) is an innovative regulatory body that often develops programs which require new processes or process changes and that have aggressive implementation timelines. In order to remain competitive, the RI Plan must implement these initiatives effectively and within prescribed deadlines / timelines and must ensure that programs continually meet contractual requirements and objectives. The C&S RI Member Advocate will be responsible for timely and effective resolution of member issues in accordance with the requirements of the Plan's Medicaid contract with RI EOHHS. The Member Advocate will assist with coordination of benefits / services for members enrolled in State Mandated programs including Children with Special Health Needs, RHODY Health Partners, Rite Care, Pain Management and Health Home initiatives. Investigate low level appeals and reimbursements. Primary Responsibilities:Responsible for resolution of issues involving benefits and services, enrollment and non-clinical service coordination.Responds effectively and timely to resolve all member benefit, service and enrollment issues.Conducts member outreach and assessment of members enrolled in State mandated programs as necessary to meet contractual requirements.Assists with coordination of services for members enrolled in State mandated programs across other functional areas and with external constituents.Ensures members receive timely referrals to internal partners and / or contracted vendors that support non-clinical member services required by State mandated programs (UBH, Rhode Island Parent Information Network (RIPIN), etc.).Addresses and reports transportation issues.Assists with resolution of ORS issues.Reports and records updated / corrected member contact information in UHC systems.May participate in process improvement, program implementation and other initiatives as needed.May participate in open enrollment functions.
Required Qualifications:High School Diploma / GED 3+ years of experience working with a managed care organization, health insurer, or consultant in a customer support or program delivery role 3+ years of experience in or exposure to Medicaid managed careProficiency within Microsoft Excel (filter, sort, create and edit spreadsheets)Proficiency within Microsoft Word (create and edit documents)Proficiency within Microsoft PowerPoint (create and edit decks)Assist with local community events - may require up to 10% travelPreferred Qualifications:Experience with or exposure to claims systemsKnowledge of benefit plans and program requirements that are typical in Medicaid managed care plan operationsExperience in benefit interpretationFamiliar with medical terminology, health plan documents and / or plan designsUnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.Careers 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 health care here. We serve the health care 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 health care, community and government partners to heal health care 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: UnitedHealth Group, UnitedHealth Care, health care, Microsoft Office, managed care, Medicaid, health insurance, customer support
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.