UnitedHealth Group Appeals Representative - Shavano Park, TX in Shavano Park-Texas, Texas
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. Positions in this function are responsible for reviewing, researching, investigating, and triaging all types of appeals and grievances.
Communicates with appropriate parties regarding appeals and grievance issues Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances.
Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions.
Analyzes and identifies trends for all appeals and grievances.
May research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians / providers. Primary Responsibilities:Ensure complaint has been categorized correctlyDetermine and confirm member eligibility and benefitsObtain additional documentation required for case reviewPlace relevant documents into image repositoryInitiate outbound contact to members or providersReview case to determine if review by Clinician is requiredResearch and resolve written complaints submitted by consumers and physicians / providersRender decision for non-clinical complaints using sound, fact-based decision makingDraft verbiage for use in outbound correspondencePrioritize and organize tasks to meet compliance deadlinesAbility to meet established productivity, schedule adherence, and quality standardsModerate work experience within own functionSome work is completed without established proceduresBasic tasks are completed without review by othersSupervision / guidance is required for higher level tasks Required Qualifications:High School Diploma or GED1+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job dutiesBasic proficiency with Microsoft Word (open / save documents), Microsoft Excel (create simple graphs), and Microsoft Outlook (send emails)Available to work 40 hours per week between 7:00 am - 7:00 pm Sunday through Saturday with overtime as neededPreferred Qualifications:1+ years of Claims / Billing experienceMedical Billing / Coding CertificateIntermediate data entry experienceExperience using any of the following claims platforms: UNET, COSMOS, CPW, ISET, NICE, FACETS, Diamond, CSP and / or UnisonSoft Skills:Strong customer service orientationStrong communication skillsSound decision making skillsAbility to navigate multiple computer systemsCareers with UnitedHealthcare.
Let's talk about opportunity.
Start with a Fortune 6 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 where ever 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.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, Shavano Park, Texas, TX 9142d446-a9d0-4abd-b05c-e343dfddded5
Appeals Representative - Shavano Park, TX TX-Shavano Park-Texas 716689