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diversity | Navigate4Me Service Navigator US Telecommute (Nationwide) in Harlingen, TX

Navigate4Me Service Navigator US Telecommute (Nationwide)

  • UnitedHealth Group
  • 25063 Dilworth Rd
  • Harlingen, TX 78552
  • Full-Time



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 training and tools in the world to help serve our existing and new customers.



This role is responsible for coordination of member navigation plans with Optum clinical and non - clinical staff supporting members in the Navigate4Me program including members referred for CHF, DHN, PSU, HPC, Advanced Illness, ESRD and Transplant. This role will work one - on - one with assigned Optum clinical and non - clinical staff and will support members and their caregivers associated with that assignment in a case management capacity. Members will be warm transferred from Optum clinical and non - clinical staff. Daily responsibilities include warm transfers of members from assigned Optum clinical and non - clinical staff, inbound / outbound calls from / to assigned members and member account research and issue resolution.



Primary Responsibilities:

  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Conduct proactive research on assigned member accounts to identify service issues and inform member plan of navigation in coordination with assigned Optum clinical and / or non - clinical staff outreach. Research includes, but is not limited to:
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Recent contacts
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Alerts
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">PCP on account
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">LIS
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Medicaid
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Appeals
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Billing
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Claims Denials
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">PAs
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Mail Order
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Transportation
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Communicate with assigned Optum clinical and / or non-clinical staff regarding member service issues that are proactively identified, member identified and close the loop on the resolution of service issues to inform the plan of navigation for assigned members.
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Resolve member service inquiries related to:
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Medical benefits, eligibility and claims
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Terminology and plan design
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Financial spending accounts
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Pharmacy benefits, eligibility and claims
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Correspondence requests
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Educate members about the fundamentals of health care benefits including:
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Managing health and well being
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Maximizing the value of their health plan benefits
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Selecting the best health plan to meet their health needs
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Choosing a quality care provider and appointment scheduling
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Premium provider education and steerage
    • auto;mso-list:l0 level2 lfo1;tab-stops:list 1.0in;background:white\">Pre - authorization and pre - determination requests and status
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Communicate with members and their care givers regarding anticipated member service needs and resolution of issues
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Research 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 experience
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Interact with executives and senior leaders to identify and / or resolve member issues including ongoing communication of issue outcome
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Build and maintain an elaborate list of business partners across all lines of business to escalate member inquiries on an as needed basis
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Employees may be asked to work independently after hours to resolve urgent issues that surface after normal business hours. This role has the ability to work outside of established procedures to ensure high level member satisfaction
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Identify gaps in processes and work closely with other departments for process improvement
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Provide education and status on previously submitted pre - authorizations or pre - determination requests
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
  • auto;mso-list:l0 level1 lfo1;tab-stops:list .5in;background:white\">Maximize use of community services, support programs, and resources available to member
  • San Antonio, TX,
    Irving, TX, Colorado Springs, CO, Roanoke, VA, St Louis, MO, Harlingen, TX or
    US Telecommute






Required Qualifications:

  • auto;mso-list:l1 level1 lfo1;tab-stops:list .5in;background:white\">High School Diploma / GED or higher
  • auto;mso-list:l1 level1 lfo1;tab-stops:list .5in;background:white\">1+ years of experience within an Advocate Role supporting one or more of the following products: MA West, MA East, Group, PDP, Outbound
  • auto;mso-list:l1 level1 lfo1;tab-stops:list .5in;background:white\">Successful completion of new hire training and demonstrated proficiency in Benefits Advocate role
  • auto;mso-list:l1 level1 lfo1;tab-stops:list .5in;background:white\">Experience in Health Care / Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design)
  • auto;mso-list:l1 level1 lfo1;tab-stops:list .5in;background:white\">Ability to work between 7:00 am - 7:00 pm

Preferred Qualifications:

  • auto;mso-list:l0 level1 lfo2;tab-stops:list .5in;background:white\">2+ years of experience in a Customer Service environment

The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well - being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time 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: MA West, MA East, Group, PDP, Outbound, customer service