Whether you’re an employer or an employee, health insurance can be a complicated maze of paperwork and programs, and it can be difficult to determine if you’re making the most of your coverage. UnitedHealthcare has someone specifically to help with that, and she happens to love her job.
"There are usually two ways an employer can fund coverage,” said Ofelia Macedo-Shuttz, Strategic Account Executive at UnitedHealthcare’s TPA United Medical Resources (UMR). “One is fully-insured, which is like auto-insurance where the insurance carrier handles all of the risk and all of the exposure. The other is self-funded, which is where the employer carries all of the risk by handling claims directly."
According to Macedo-Shuttz, one of the best parts of her job is answering those questions and helping organizations find the right blend of coverage services to fit their goals and stay within the budget.
“It's not a one-size-fits-all situation,” she said. “The challenge is learning your group— each group is different for a variety of different reasons— trying to meet their needs, and still keeping the cost containments under consideration."
While Macedo-Shuttz’s day-to-day workflow varies, it usually involves some combination of assisting clients with navigating the transition from another TSA or insurance plan, answering benefit-level questions, and meeting with clients to review claims data and make service improvement recommendations.
"If we review reports and see a group has a high prevalence of ‘xyz’ condition, we’ll discuss programs that can help address that and manage that condition better for their population," she said.
For example, if a group has a high rate of obesity or obesity-related conditions, Macedo-Shuttz and her team might recommend encouraging members to join UnitedHealthcare’s "Real Appeal" program. Real Appeal provides members with a coach, digital tools, and a success kit to help build long-term weight-loss and health-conscious habits through a series of small goals.
"I wish people understood their benefits better and how to use them to their fullest extent. I think that's how we become much more informed consumers," she said.
Macedo-Shuttz finds these opportunities to visit with clients and their employees to be a particularly rewarding aspect of her role at UMR.
"Sometimes we attend benefits, fairs, or open-enrollment meetings to answer questions directly from employees," Macedo-Shuttz said. “You get to meet individuals that you're impacting directly, and it means so much more than a name on a spreadsheet."
To learn more about UMR programs and coverage options, visit their website: https://www.umr.com/.