Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together** Positions in this family have the primary responsibility of providing telephonic customer service. Positions in this function are responsible for providing expertise and customer service support to members, customers, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries. **Primary Responsibilities:** + Some work is completed without established procedures + Basic tasks are completed without review by others + Supervision/guidance is required for higher level tasks + Applies knowledge/skills to activities that often vary from day to day + Demonstrates a moderate level of knowledge and skills in own function + Requires little assistance with standard and non-standard requests + Solves routine problems on own + Works with supervisor to solve more complex problems + Prioritizes and organizes own work to meet agreed upon deadlines + Works with others as part of a team + PHO_Provide Phone Support to Drive Resolution of Caller Questions/Issues Proficiency Level: Developing + Demonstrate understanding of internal/external factors that may drive caller questions/issues (e.g., recent plan changes, mass mailings, call directing/rerouting, weather emergencies) + Ask appropriate questions and listen actively to identify underlying questions/issues (e.g., root cause analysis) + Gather appropriate data/information and perform initial investigation to determine scope and depth of question/issue + Identify and coordinate internal resources across multiple departments to address client situations, and escalate to appropriate resources as needed + Proactively contact external resources as needed to address caller questions/issues (e.g., providers, labs, brokers) + Utilize appropriate knowledge resources to drive resolution of applicable questions/issues (e.g., websites, CRM tools, Onyx, Siebel, knowledge bases, product manuals, SharePoint) + Identify and communicate steps/solutions to caller questions/issues, using appropriate problem-solving skills and established guidelines, where available (e.g., workarounds, descriptions of relevant processes) + Offer additional options to provide solutions/positive outcomes for callers (e.g., online access to relevant information, additional plan benefits, workarounds for prescription delays) + Make outbound calls to resolve caller questions/issues (e.g., to callers, providers, brokers, pharmacies) + Drive resolution of caller questions/issues on the first call whenever possible (e.g., first-call resolution, one-and-done) + Ensure proper documentation of caller questions/issues (e.g., research conducted, steps required, final resolution) + PHO_Develop and Maintain Productive Relationships/Interactions with Callers Proficiency Level: Developing + Manage caller conversations appropriately (e.g., provide a good first impression, command attention and respect, maintain professional tone, demonstrate confidence, de-escalate/defuse callers as needed) + Apply knowledge of applicable Service Level Agreements (SLAs) and Performance Guarantees when interacting with callers + Maintain ongoing communications with callers during the resolution process to communicate status updates and other required information + Maintain focus on caller interactions without being distracted by other factors (e.g., system usage, pop-up alerts, VCC data) + Acknowledge and demonstrate empathy/sympathy with callers' life events (e.g., wedding, birth of baby, loss of relative, recent illness) + Demonstrate knowledge of applicable health care terminology (e.g., medical, dental, behavioral, vision) + Demonstrate knowledge of applicable products/services (e.g., benefit plans, disability, COBRA, FSA, HRA) + Obtain and apply knowledge of benefit structures/designs for contracted or acquired companies + Ensure compliance with applicable legal/regulatory requirements (e.g., HIPAA, state/regional requirements) + Maintain knowledge of information/process changes due to healthcare reform, referring to applicable company resources (e.g., dependent age, removal of lifetime limits, free preventive care services, Medical Loss Ratio) + Demonstrate knowledge of established workflows and support processes (e.g., available resources, internal/external business partners, points of contact) + Demonstrate knowledge of relevant internal processes impacting caller issues (e.g., claims processing, auto-adjudication) + Identify inaccurate/inconsistent information found in systems/tools, and communicate to appropriate resources (e.g., IBAAG, SOP, AYS, SPDs, policies/procedures) + PHO_Provide Consulting/Education on Caller Issues/Trends Proficiency Level: Developing + Communicate common problems/questions presented by callers to appropriate Subjects Matter Experts, to drive continuous improvement + Educate callers on available products/services (e.g., features, functionality, options, additional offerings, preventive services, agerelated services) + Educate callers on self service resources available to them, and on their responsibilities with regard to their health care coverage + Refer callers to other resources applicable to their questions/issues, where appropriate (e.g., pharmacists, prior authorizations, billing department) + Review/analyze phone support data/metrics and communicate patterns/trends to internal stakeholders, as needed (e.g., leadership, Subject Matter Experts, business partners) + Provide training/mentoring to other team members, as needed (e.g., new-hires, refresher training) + Participate in customer site visits, as needed (e.g., to obtain feedback, provide education, clarify support processes, highlight company performance) + Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so **Required Qualifications:** + High school education or equivalent experience + Moderate work experience within own function **Values Based Competencies:** + Integrity Value: Act Ethically + Comply with Applicable Laws, Regulations and Policies + Demonstrate Integrity + Compassion Value: Focus on Customers + Identify and Exceed Customer Expectations + Improve the Customer Experience + Relationships Value: Act as a Team Player + Collaborate with Others + Demonstrate Diversity Awareness + Learn and Develop + Relationships Value: Communicate Effectively + Influence Others + Listen Actively + Speak and Write Clearly + Innovation Value: Support Change and Innovation + Contribute Innovative Ideas + Work Effectively in a Changing Environment + Performance Value: Make Fact-Based Decisions + Apply Business Knowledge + Use Sound Judgement + Performance Value: Deliver Quality Results + Drive for Results + Manage Time Effectively + Produce High-Quality Work _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._ _Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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._ _Optum is a drug-free workplace. © 2024 Optum Global Solutions (Philippines) Inc. All rights reserved._