C&S Escalation Team SME – Remote

UnitedHealth Group
September 27, 2021
Atlanta, GA
Job Type


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

The Community and State (C&S) Escalation Team SME position is responsible for providing expertise and customer service support to coworkers in the Tier I Role Government Operations to ensure their ability to maximize the value members receive from their health benefits program, connect members with quality care providers, and advocate for resolution of any issues or barriers that arise.

Positions in this function are responsible for providing expertise and customer service support to internal and external customers, members, and/or providers. Direct phone-based customer interaction to answer and resolve a wide variety of inquiries. Training will be conducted virtually from your home.

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

Primary Responsibilities:

  • Acts as a champion of issue resolution for the plans supported; responsible for any follow-up work needed to resolve member/provider issues; anticipate member needs to reduce member effort
  • Service may be provided to coworkers, members, customers, and/or providers. Support is provided via multiple channels (phone, written, in-person) in order to answer and resolve a wide variety of inquiries.
  • Acts as a champion for all Tier I processes and metrics (i.e. Gaps in Care, HRA, and Appointments
  • Partners with Supervisor, Business Managers, and Associate Directors to ensure escalated member issues are addressed
  • Demonstrate leadership by complying with all current policies/procedures/workflows; empowered and expected to request updates to out of date processes and procedures for plans supported
  • Meet member experience, quality, productivity and attendance requirements
  • Mentors and acts as a resource for others
  • Maintain proficiency in all technical applications (technical skills and system knowledge)
  • Works independently, plans, prioritizes, organizes and completes work to meet established objectives
  • Intervene and handle escalated member calls through transfers from Benefit Advocates handling inquiries for any products including Medicaid, Medicare and others
  • Support advocates with complex questions/inquires
  • Support production calls as required
  • Other ad-hoc task as assigned by leadership
  • May act as Point of Contact in absence of leadership
  • Assists with Social Media, Health Plan, Sales and Executive escalations/complaints
  • Assists with Members In Distress project and various other duties as assigned for operational account management for the Medicaid population

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) OR 3+ years of equivalent work experience
  • 1+ years of office or UHG Customer Service experience analyzing and solving customer problems
  • Familiarity with computers and Windows PC Applications (this includes the ability to learn new and complex computer system applications)
  • Ability to work Monday – Friday, 8-hour shifts during business hours of 7am – 10pm 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:

  • 1+ years of current or prior work experience within UHC Call Center Benefit Government Operations
  • 1+ years of Community & State experience
  • Experience using the Facets and Macess platforms
  • Intermediate or higher-level experience in Microsoft Excel (Pivot tables, formulas, VLOOKUPs, formatting)
  • Experience in Microsoft Word (creating and editing documents)

Physical 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 https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 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.

Keywords: SME, NEST, escalations, GO, government, M&R, C&S, DSNP, Advocate4me, Navigators, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO

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