Apply knowledges / skills to activities that often vary from day to day Demonstrate a moderate level of knowledge and skills in own function Make outbound calls to members who are eligible to participate in one of our Health Management coaching programs Receive inbound calls to enroll members & / or provide customer service Require little assistance with standard and non

Organize and manage incoming claims Work through a queue with other team members to identify claim needs Identify billing discrepancies Determine member insurance coverage and eligibility status Ensure compliance with federal and state laws and regulations Sort and organize appeals to identify eligibility needs Communicate with legal teams on appeal status Make offers to

Address any escalated issues sent to them, the SAE, or other field employee Work with the central team and their manager to coordinate resolution Meet with customers quarterly (or more often if requested) to review service related statistics including ideas for improving or enhancing the customer's total service experience Conduct training/education with customers on UHC

Develops business relationships with agents and / or brokers in order to renew existing accounts Independently decides which brokers to focus on and which products to recommend Promotes sales of health care products to small business (2 to 99 employees) customers, through brokers Educating and keeping brokers up to date on UnitedHealth Care products and pricing Evaluating

Manage the installation of assigned accounts and direct structure building and billing set up Oversee overall employer contract loading using various databases and/or source documents Research installation issues and develop customers specific solutions Audit contract loads for adherence to quality measures and reporting standards Manage and be accountable for employees a

Collaborates with the University Bursar, Registrar, IT Services and Web Services departments to ensure smooth processes throughout the insurance plan year. Coordinates the administrative aspects of a competitive bid process for USHIP and the optional insurance plans. Maintains the University Student Health Insurance Administration Tool, which tracks students' annual enrol

Manage and monitor client assignments Training of account management staff, new hire and ongoing Maintain an acceptable level of persistency in teams book of business Recruit, hire and monitor account management staff Personnel development and management Set account management strategy to achieve goals Direct and manage service plans Build and maintain key client and prod

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Participates in the application technical design process with the Application Architects on development projects Ensures and contributes to testability of requirements and/or user stories Clarifies ambiguities in requirements, user stories, design and other artifacts produced as part of the product lifecycle Develops, implements, and maintains quality and test procedures,

Develop and execute a human centered product roadmap to enhance existing, or develop new, user experiences Work with other organizational leaders (e.g. Design, Content, UX and Development) to develop and communicate a comprehensive product vision and roadmap in support of strategic business initiatives Collaborate with applicable business partners and stakeholders to cond

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Com

Research issues and develop customers specific solutions Provide in person Member services to both M&R and DSNP members with their languages at retail store, services including but not limited to Benefits Policies, Procedures, and protocols (pre auth, enrollments, renew rewards, etc.) Claim / billing issues (follow up calls with resolution to identified issues in timely m

As requested, provide support to consumer or family members in making needed appointments Work with the Clinical Program Managers and the Clinical team to implement intensive, enhanced care coordination when requested, which may include peer support as well as other community based services designed to stabilize the consumer's condition, including working with the consume

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with patient, family, and healthcare providers Identify and initiate referrals for social s

Assist with care management for high medical risks / needs members with comorbid behavioral health needs As a Care Coordinator Assess members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person centered