Senior Complex Customer Care Representative - National Remote

UnitedHealth Group • Atlanta, GA

392d • $40,498 - $79,206 • Remote

About The Position

The Senior Complex Customer Care Representative role at Optum is designed to provide exceptional support to members navigating their healthcare benefits. This position focuses on building relationships, guiding members through their health journeys, and ensuring they have access to the necessary resources. The representative will act as a healthcare navigator, addressing complex issues related to claims, benefits, and social determinants of health, while delivering a consultative member experience across various health and wellbeing programs.

Requirements

• High School Diploma / GED or equivalent work experience.
• Must be 18 years of age or older.
• 2+ years of high-demand contact center and/or customer service experience in a professional environment.
• 1+ years of experience in the Healthcare Field, Advocacy Service, Customer Service, and/or Call Center Services, Sales, Hospitality.
• Sales experience with the ability to influence consumer behavior.
• De-escalation experience to ensure consumers feel heard and cared for.
• Familiarity with computer and Windows PC applications, with the ability to learn new applications.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint, Outlook).
• Ability to work full-time, 8-hour shifts during normal business hours from 8:00 AM - 11:00 PM EST, including Saturdays.

Nice To Haves

• Experience with medical or health terminology.
• Multilingual proficiency (e.g., English and Spanish).

Responsibilities

• Build and maintain strong relationships to provide premium level service and end-to-end resolution for members.
• Answer up to 30 to 60 incoming calls, emails, and chats per day from members of health/dental/vision/pharmacy plans.
• Contact care providers on behalf of customers to assist with appointment scheduling or connections with internal specialists.
• Demonstrate expertise in claims processing and interpretation, resolving claim-related issues efficiently.
• Identify areas of assistance and offer resolution for benefits, eligibility, claims, and financial spending accounts.
• Educate members about managing their health and well-being.
• Assist in navigating UnitedHealth Group websites or applications using remote desktop capabilities.
• Construct communication via secure messaging, email, or chat.
• Research complex issues across multiple databases and work with support resources to resolve member issues.
• Navigate through multiple platforms to retrieve information regarding various health plans and accounts.
• Meet performance goals in effectiveness, efficiency, call quality, member satisfaction, and first call resolution.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED