NEC Escalation Team Representative - Remote

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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. SM

It's a big step forward when you realize that you've earned the trust to lead a team. Now, let's determine just how big that step can be. Take on this role with UnitedHealth Group and you'll be part of a team that's reshaping how health care works for millions. Now, you can take advantage of some of the best resources and tools in the world to help serve our members. You'll play a lead role in a high volume, focused and performance driven call center where the goal is always to connect with members and enhance the customer experience. This is no small opportunity. This is where you can bring your compassion for others while building your career.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of 7:00am - 7:00pm central. It may be necessary, given the business need, to work occasional overtime. This role does participate in shift bidding twice a year.

Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:

• Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member
• Resolve escalated member service inquiries
• Intervene with care on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance. Effectively refers and enrolls members to appropriate internal specialists and programs, based on member's needs and eligibility
• 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.
• Ability to overcome objections and persuade members to take action and/or change behavior
• Respond to and resolve on the first call, all customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence. Focus on CTM prevention is a key responsibility, reduced CTMs is critical to STARS ratings and ongoing success of the team
• Interacts with executives and senior leaders identify and/or resolve member issues including ongoing communication of issue outcome
• Builds and maintains an elaborate list of business partners across all lines of business to escalate member inquiries on an as needed basis
• Provide critique as needed to Tier 1 advocates to enhance overall member experience. Acts as the escalation point for members requesting to speak to a supervisor, agents are empowered to resolve issues with the same urgency and outcomes as a Tier 1 supervisor
• Employees in this role are empowered to make (limited) service and monetary decisions when needed to resolve escalated issues, issues related to billing, claims, benefits as well as atonement items like flowers, token gifts, etc. to create a memorable experience
• 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
• Identify gaps in processes and work closely with other departments for process improvement
• Provide education and status on previously submitted pre-authorizations or pre-determination requests
• Meet the performance goals established for the position in the areas of: efficiency, call quality, customer satisfaction, first call resolution and attendance
• Maximizes use of community services, support programs, and resources available to member

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High school diploma / GED (or higher)
• 1+ years of experience building rapport and responding to customers in a compassionate manner by identifying and exceeding customer expectations (responding in respectful, timely manner and delivering on commitments)
• Experience with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications. In this case, moderate is defined as ability to set up a meeting in Microsoft Outlook and respond to emails and add attachments as well as navigate through Microsoft Excel spreadsheet and sort and filter.
• Ability to work Monday - Friday, 8-hour shifts during business hours of 7:00am - 7:00pm CST, with flexibility to work weekends and overtime as needed, and the individual will participate in a shift bid
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

• Associate's degree (or higher) or Bachelor's degree
• 2+ years in a Customer Service environment
• 1+ years of experience working in Government Operations Medicare & Retirement

Soft Skills:

• Ability to multi-task including ability to understand multiple products and multiple levels of benefits within each product

Physical Requirements and Work Environment:

• Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
• Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule, and work over-time and/or weekends, as needed

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM

Colorado Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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.

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