Own the service experience of customers at the field level by working with the assigned team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customer's expectations Develop and maintain strong relationships with internal partners throughout UHG to manage the customer service experience Fully accountable for supportin

Serve as primary contact as it relates to all enrollment tasks for assigned book of business, which include multiple group customers; maintain satisfied customers by providing superior service and practice attention to detail in various responsibilities. Answer member, provider, and group customer phone calls; adhering to department expectations for answering calls and pr

Compiles financial statements for various Management and Labor customers in prescribed formats by collecting financial data from Peoplesoft General Ledger and other finance data repositories while ensuring accuracy and consistency Prepares standard daily and month end journal entries pertaining to revenues and expense, reclassification entries and month end reconciliation

Administration of Pension Benefits Collection of data from pension participants to determine eligibility and vesting schedule. Answer questions via telephone and email to convey information regarding the provisions of the pension plans. Create various types of members or employer correspondence including letters and emails. Collection and data entry of participant hours w

Partner with community providers of peer support to expand the network and ensure quality services are available for our members Educate by creating new curriculum specific to state need and facilitate community trainings Model the principles of recovery and provide member perspective to our CM, UM, Network, Product and Affordability partners Advocate for a recovery persp

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease 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 Co

Manage projects from inception to completion through QI science methodology documentation including Project charters, PDSA cycles, Key Driver Diagrams, GEMBAs, Run Charts and Paretos Complete data analysis for projects to determine progress and if SMART aims are achieved or root causes of performance Lead multidisciplinary teams to complete project tasks Recommend appropr

Solid understanding of both fully insured and self funded marketplace and pricing disciplines Establish and maintain "strong and appropriate" level relationships with customers and consultants; ensure UHG senior management has customer specific "board level" contacts Develop and monitor client financial performance including renewal planning, negotiation and profitability

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

Analyze, review, forecast and trend complex data Present analysis and recommendations for operational and business review/planning Support short and long term operational/strategic business activities through analysis Develop, recommend and implement business solutions through research and analysis of data and business processes This is a complex, fast paced, matrixed env

Make determinations of medical necessity/clinical appropriateness of treatment Assist in the development and implementation of clinical policy, guidelines and applications Regularly contact providers whose treatment determinations indicate a trend that varies with their peers and community Be knowledgeable on and apply all necessary regulatory requirements for assigned re

Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies, render coverage determinations Document clinical review findings, actions and outcomes in accordance with policies, and regulatory and accreditation requirements Engage with requesting providers as needed in peer to peer discussions Be knowledgeable in

Build and maintain solid relationships with key brokers and others as necessary within the assigned territory Develops action plans and strategies to optimize Medicare sales Partner with peers and the Sales Director (SD) to identify and develop relationships with individuals and organizations that influence the buying behavior of our target consumer (e.g., Providers, Regu

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

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