Position Description:Energize your career with one of Healthcare's fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our Service Centers, improve our Service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 14 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their Healthcare needs, and stay on track with their Health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation, and Performance. Primary Responsibilities: Meets with Sales and Client Implementation Lead to understand client commitments in regards to operational deliveryReviews new client documents such as the Request for Proposal, Master Contract and Performance Guarantees to identify Customer Service RequirementsIdentifies Performance Guarantees and requirements that will impact operational delivery targets for new clients. If necessary modifies operations processes and or performance measurement process / metricsCreates implementation project plan for individual client as assignedDefines key milestones and deliverables; builds out the customer service operational readiness plan (key issues, risks, mitigation plan)Identifies all stakeholders needing communication regarding new clients. Develops and delivers communicationCommunicates all client requirements to Operations, Training, Telecom and Workforce leadsWorks with Workforce Management Lead to determine FTE impacts based on new client population and call volume forecastDetermines incremental staff needed by role and reviews FTE impact with VP of Operations for approvalPartners with call center site leadership to identify location of staffCollaborates with Operations to determine the staffing approach if incremental staff is needed (new hires versus existing staff)Performs gap analysis to compare current operations design to new client expectations / commitmentsIdentifies updates or additions to job aids, processes, and training contentObtains sign off on process changes and posts approved content to appropriate tool such as myRxAdvisor (department knowledge base tool) Reviews existing Quality Scorecard to determine if updates are neededWorks with Quality team to update audit toolCommunicates new / changed quality expectations to Quality team and to Supervisors and agents. Example – use "prescription drug list" and not "formulary," use "brand" and "generic" and not copay tier. Use "warm transfer" and not cold transfer. Posts revised Scorecard to myRxAdvisor Performs gap analysis to compare current training curriculum / agenda to new client expectations / commitmentsCoordinates updates with Training LeadCreates Account Information document for new client (template)Uploads Account Information document into myRxAdvisorDetermines if a training update is needed - notification of new client, new or revised processIdentifies staff to train by role and by siteBuilds the training plan and schedule with the Training Delivery LeadDetermines client requirements for Customer Service Toll Free No. (TFN) - Custom greetings, international calls and Spanish language supportCreates Telecom work intake for toll free number, skilling, and NodeCommunicates all Telecom information to Operations and Workforce Leads (TFN, Skill, Node)Participates in pre-Go-Live Telecom testingDetermines that Workforce Lead has skilled and scheduled agents for go-liveDetermines client reporting requirements and creates Reporting work intakeExecutes a launch readiness checklist – staff, job aids, Telecom, TechnologyParticipates and or facilitates post deployment checkpoints Build, manage and maintain relationships with Operational peersAttend Client MeetingsIdentify and report system problems in relation with benefit installation and interpretation clarificationsInvestigate and manage implementation issues through root cause analysis and communicate outcome (telephonically or written) to internal partners and external clients Drive process improvement based on trend analysis / lessons learned from monthly implementationsDrive process improvement with Client Management and audit remediation teamHost and / or lead client site visits and travel to meet with new or existing clients as needed
Required Qualifications:High School Diploma / GED (or higher)2+ years of customer service experience1+ years of experience in OptumRX operations with demonstrated expertise of IRIS, RXHD / Navigator, MyRXAdvisor, and / or RX Claims systemsExperience using Microsoft Word, Microsoft PowerPoint, and Microsoft Excel to create project plans, communications, client documents, presentations, tracking and reportingKnowledge of pharmacy terminologyExperience with verbal and written presentationsExperience analyzing and solving benefits and claim issuesExperience with building customer service relationshipsExperience managing or leading projectsExperience in claims payment, claims adjustments and / or enrollment Ability to work Monday through Friday between 7:00 am - 6:00 pm with weekends, overtime and holidays as needed (First quarter is usually overtime)Preferred Qualifications:Implementation experienceSoft Skills:Strong organizational skills and attention to detailSerious team playerExtremely meticulous OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing 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 claims, RxHD, IRIS, enrollment, benefits, healthcare, Optum
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.