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Consumer Advocate - Waltham, MA

UnitedHealth Group

Waltham, MA
Job Code:
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Job Details

Consumer Advocate - Waltham, MA(Job Number:720144)

Position Description:

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

Positions in this function are responsible for resolution of escalated issues with external and internal customers. Responsible for the overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership. Charged with project collaboration and coordination to improve the overall member experience.


Primary Responsibilities: 

  • Uses pertinent data and facts to identify and solve a range of problems within area of expertise (such as member issues or operational concerns).
  • Investigates and resolves non-standard requests and problems, with limited assistance from others.
  • Works with several knowledge areas and departments.
  • Prioritizes and organizes own work to meet deadlines.
  • Provides explanations and information to others on topics within area of expertise. 

Functional Competency & Description Proficiency Level

Support Client Satisfaction

  • Establish credibility with members to enhance client outcomes (e.g., knowledge of the healthcare and insurance industries, market specific information, best practices)
  • Demonstrate understanding of member requests to ensure that their needs are being met
  • Serve as liaison between members and internal business leaders to ensure mutual understanding of needs and clear expectations by all stakeholders
  • Proactively contact members as needed (e.g. enrollment, disenrollment, redetermination and employee subsidy) to ensure effective delivery of our solutions and solicit customer feedback
  • Respond to escalated inquiries, grievances and appeals requiring coordination with members, providers, sister segments and internal departments (such as provider relations and quality).
  • Support State Board of Hearings appeal preparation as requested
  • Demonstrate understanding applicable systems / procedures in order to provide appropriate information to clients (e.g., workflows, claims processing systems, claims payment methodology)
  • Identify member scenarios that are not meeting mutual needs, and recommend appropriate course of action (e.g., inability to meet member expectations, inappropriate operations, etc.)
  • Manage the Service Quality Improvement Committee
  • Support efforts to evaluate and analyze member satisfaction metrics/data through the Service Quality Improvement Committee and participate in action plans to increase member satisfaction.  

Drive Resolution of Issues for Members

  • Execute resolution of member issues
  • Identify and coordinate internal resources across multiple business units to address escalated client situations
  • Advocate for the member with internal audiences to ensure that client needs are being met
  • Manage member expectations to ensure understanding of our capabilities and limitations
  • Perform required research/analysis to drive resolution of member issues (e.g., root cause analysis)
  • Channel member issues to appropriate resources, as needed (i.e., when to escalate, whom to notify)
  • Support Critical Incident Report requirements as needed
  • Identify, suggest and, if appropriate, implement process improvements to increase efficiencies and improve customer service / A&G 
  • Ensure that member issues are resolved to highest possible mutual satisfaction (e.g., information gathering, follow-up, timeliness)
  • Synthesize and communicate information on member issue status and resolution to appropriate internal / external stakeholders
  • Respond to the daily inventory report (queues from other corporate areas) and ensure complete and timely resolution of assigned items 

Develop / Manage Relationships with Applicable Stakeholders

  • Coordinate with other internal functions and business leaders to complete projects and address ongoing service needs
  • Develop relationships and collaborate with external stakeholders (e.g., A&G, Call center, sister segments) to identify their needs and ensure proper delivery of our services  / solutions, as needed
  • Support plan level consumer advisory council
  • Develop and implement focus group activities that result in actionable feedback to the plan
  • Represent the plan to external stakeholders at external meetings (e.g. advocacy organizations)
  • Coordinate and collaborate on special projects

Job Service Account Management
Primary Location US-MA-Waltham
Other Location 
Organization C&S Massachusetts ABD LTC
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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