Service Account Manager Associate - Phoenix, AZ

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.AmeriChoice, a UnitedHealth Group company, is a recognized leader and innovator in providing managed health care solutions to its membership, which includes Medicaid, Medicare and SCHIP beneficiaries.  With over a decade of growth and success, we are poised for continued expansion of our services in this dynamic marketplace. Our commitment to this specialized market makes a genuine difference in the lives of our 1.8 million members. Join us, do rewarding work, and build a great career.   Position Description:  This position is responsible for stakeholders’ timely telephone access to accurate information regarding our health plan or the program. The Member Services Representative ensures the appropriate triage of all calls including information inquiries, service requests, referrals, grievances, appeals, claims disputes and QOC issues. The Member Services Representative will have experience in provision of member services and complaint resolution in compliance with Federal and State laws and the requirements of the relevant contract.   Primary Responsibilities: Provide education on the program and health care access for applicants, potential members, and members utilizing established protocols, procedures, and educational methodologies in an accurate and courteous manner Provide all services in a culturally competent manner and with respect for the individual and their clinical needs Encourage members to appropriately utilize services in an effort to improve the health and well being of all members, including education about the importance of childhood immunizations and appropriate utilization of the emergency room Provide ongoing education for members based on individual needs identified through questions or conversations, which may include targeted education on availability of dental services, lead screening, or keeping appointments with the lead specialist Provide potential applicants with general health plan information and assist applicants in selecting an appropriate means of applying for benefits Assist providers with eligibility issues, policy education and member interventions Facilitate complaint/resolution and issues in a timely and sensitive manner Determine when an issue or complaint requires higher-level review or case review and document the information to ensure prompt and accurate escalation of the issue Follow and adhere to the guidelines of the Issue, Grievance, and Appeals process when appropriate Assist the member in selecting a lead specialist, when appropriate Education members on the importance of appropriate utilization of a lead specialist and the services that are covered Assist members in identifying program resources such as transportation or home health service providers Develop knowledge of and links to community-based organizations to improve access to services Document contacts with members in the database completely and accurately to ensure accurate tracking, statistics, and member historyQualifications: Bachelor's degree in a related field preferred High school diploma required Computer experience including Microsoft word and Excel required  1 year of experience in member services required Apply knowledge/skills to a range of moderately complex activities Demonstrates great depth of knowledge/skills in own function Sometimes act as a technical resource to others in own function Proactively identify solutions to non-standard requests Solve moderately complex problems on own Work with team to solve complex problems Plan, prioritize, organize and complete work to meet established objectives May coordinate work of other team membersDiversity creates a healthier atmosphere: equal opportunity employer M/F/D/V   UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.