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

Engage members either face to face or over the phone to have a discussion about their health Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care) Conduct comprehensive member assessment that includes bio psychosocial, functional, and behavioral health needs Utiliz

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

Forge relationships with key customers and consultants, and act as main contact for UnitedHealthcare and as "CEO" of their account Renew the customer year over year in the 100 3000 lives segment Clearly demonstrate the value propositions for specialty and ancillary business to improve customer growth and retention Develop and monitor client financial performance, includin

Program Administration Collaborates with key university departments (Registrar, Bursar, IT Services, University Communications and Marketing, Health Services. Student Life, etc.) to ensure processes pertaining to the SHIP are as smooth and seamless as possible throughout the insurance plan year. Regularly assesses and facilitates the implementation of the annual online st

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,

Analyze, review, forecast, and trend complex data Present analysis and interpretation for operational and business review and planning Support short and long term data warehousing activities through analysis Develop recommended business solutions through research and analysis of data and business process and implement when appropriate Skills with influencing others to get

Engage members either face to face or over the phone to have a discussion about their health Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care) Conduct comprehensive member assessment that includes bio psychosocial, functional, and behavioral health needs Utiliz

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