Service Advocate (FT) – Northwest Physicians Network – SeaTac, WA

The role of the Services Advocate is to build trusted relationships with members across their health care lifecycle. This is done by assisting members with their customer service needs, educating members about management of their health and well being, helping members to maximize health plan benefits and personal health care dollars and owning customer service inquiries through to resolution. Another purpose of this position is to support the mission, vision and values of the organization and department through quality, service, innovation, integrity, teamwork and dignity/respect. The employee specifically contributes to organizational/departmental success.

Northwest Physicians Network creates the opportunity for independent private practitioners to thrive in Washington State. By providing clinical integration support and data driven quality improvement, we have created a high value delivery network, making it possible for our providers to remain focused squarely on their patients.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Accountable for problem resolution of customer issues and to communicate resolution to appropriate parties.
• Available, as scheduled, to respond to calls from customers regarding claims payments, benefits, eligibility, and certification issues.
• Investigate issues and document steps taken to achieve resolution.
• Manage resolution of issues through contact with the claims department, case management, and external payers ultimately achieving a positive outcome.
• Investigate and handle retro-certification activities, as required for resolution of customer issues.
• Respond to customers regarding status of formal complaints or appeals.
• Escalate issues to Senior Customer Service Reps when appropriate.
• Meet departmental standards for schedule adherence.
• Participate in training and self-development opportunities when appropriate.
• Demonstrate a cooperative, positive attitude in the workplace.
• Demonstrate a basic knowledge of managed healthcare and claims.
• Perform all other duties as deemed appropriate to provide customer service
• Answer and respond to member inquiries regarding effective and efficient handling of incoming call/claim issues
• Ability to review and handle appropriately:
• Network and member contract questions
• Claims Issues
• Pharmacy/vision/dental/chiropractic issues
• Coordination of Benefits (Medicare Estimation and when is applies)
• Adhere to quality improvement initiatives.
• Special projects as required
• Resolve member service inquiries related to:
• Medical benefits, eligibility and claims
• Financial spending accounts
• Pharmacy benefits, eligibility and claims
• Correspondence requests
• Educate members about the fundamentals of consumer-driven health care including:
• Managing health and well being
• Maximizing the value of their health plan benefits
• Choosing a quality care member
• Premium member education and steerage
• Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
• Help members navigate myuhc.com, lifeprinthealth.com, and other UnitedHealth Group websites
• Research complex issues across multiple databases and work with support resources to resolve member issues
• Connect members with internal specialists for assistance when needed
• Partner with others to resolve escalated issues
• Provide education and status on previously submitted pre-authorizations or pre-determination requests.
• Mentor new hires and existing staff in the efficient use of call handling best practices designed to ensure accurate and consistent call responses
• Launch outbound calls as appropriate

MINIMUM QUALIFICATIONS

• Ability to empathize and project a strong understanding of member/member needs
• Associate degree or equivalent experience preferred
• Customer service background required
• Healthcare experience preferred
• Quality focused
• Ability to type 30+ WPM is required
• The ability to work in a Windows based environment is required
• Knowledge of HMO/PPO/Medicare Plans/benefits and medical terminology is preferred
• 2 years call center and or customer service experience are required
• Bilingual preferred
• Authorization to work in the United States
• Available to work 40 hours per week anytime within the operating hours of the site, which may include weekends and holidays

Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(SM)

Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.