- Entry level
- No Education
- Salary to negotiate
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.SM
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) with the scheduled shift hours of 7:00 am - 8:00 pm - Sunday through Saturday. It may be necessary, given the business need, to work occasional overtime or weekends.
Review, research and understand how a claim submitted by consumers 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.
High School Diploma / GED (or higher) or 10+ years of equivalent working experience
1+ year Customer Service Representative (CSR) experience or 1+ year experience in an office setting, call center setting or phone support role
Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
Previous experience with medical claims processing
Ability to compose written correspondence free of grammatical errors while also translating medical and insurance expressions into simple terms that members can easily understand
Ability to remain focused and productive each day though tasks may be repetitive
Ability to multi - task, including the ability to understand multiple products and multiple levels of benefits within each product
Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well - being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic
About the company
Our mission is to help people live healthier lives and to help make the health system work better for everyone.
A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 85 million people worldwide.
Our biggest point of differentiation is our people - and the collective talent, energy, intelligence and drive our force of 188,000 individuals around the world bring to our mission every single day. So, how do we do it? With our every action, interaction and intention that demonstrates the five fundamental values that guide everything we do: