Position Description:Reward yourself with a career that will thrive. Apply now for classes starting soon to reap the benefits of a career with UnitedHealth Group!You're looking for a career where your performance will be rewarded. When you join UnitedHealthcare's Appeals Group, you'll be part of a team committed to constantly challenging ourselves to improve in key performance areas. Here your performance will be rewarded as success is expected, measured and rewarded with increasing opportunities, responsibilities, and performance based pay incentives. You'll be empowered to serve members in key markets and geographic regions with a broad range of health benefit products including employer-sponsored health plans, members enrolled in Medicare and Medicaid, as well members who purchase their own health plans. At UnitedHealth Group, you're not just a team member. You're part of an elite, Fortune 14 team that's equipped with the best tools and resources, the most thorough training and learning opportunities and a mission that can inspire you every day to do your life's best work.As an Appeals Representative, we will depend on you to communicate some of our most critical information to the correct individuals regarding appeals and grievance issues, implications and decisions. You will support teams with reviewing, researching, and understand how a claim was processed and why it was denied. You will need a high degree of follow through, attention to detail, and proficiency with verbal and written communication. This position is full-time (40 hours / week) Monday through Friday. It may be necessary, given the business need, to work occasional overtime or weekends. Primary Responsibilities: Review, research and understand how a claim submitted by members and physicians / providers was processed and determine why it was denied Identify and obtain all additional information (relevant medical records, contract language and process / procedures) needed to make an appropriate determination of the appeal on the claim Make an appropriate determination about whether a claim should be approved or denied based on the available information and research Determine whether additional appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper department for their review and decision / response Complete necessary documentation of final documentation of final determination of appeals or grievance using the appropriate templates, communication process, etc. (e.g. response letters, customer service documentation) Communicate appeal or grievance information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.) Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
Required Qualifications: High School Diploma / GED (or higher) Familiarity and fluency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications Ability to compose written correspondence free of grammatical errors while also translating medical and insurance expressions into simple terms that members can easily understandPreferred Qualifications:1+ years of Customer Service Representative (CSR) experience or 1+ years of experience in an office setting, call center setting or phone support role Previous experience with medical claims processingSoft Skills: Ability to multi-task, including the ability to understand multiple products and multiple levels of benefits within each productThere are several steps in our hiring process - it's a thorough process because we want to ensure the best job and culture fit for you and for us. In today's ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you'll receive an email with next steps. This may include a link for an on-line pre-screening test that we ask you to complete as part of our selection process. You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail.Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing marketsegment in healthcare. And we are the largest business in the nation dedicatedto serving their unique health and well-being needs. Up for the challenge of alifetime? Join a team of the best and the brightest to find bold new ways toproactively improve the health and quality of life of these 9 millioncustomers. You'll find a wealth of dynamic opportunities to grow and develop aswe work together to heal and strengthen our Healthcare system. Ready? It's timeto do your life's best work.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: claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, UnitedHealthcare, training class, customer service representative, customer service, CSR, Data Entry, appeals, dispute resolution, phone support
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.