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Appeals Representative - New Hyde Park, NY

UnitedHealth Group


Location:
NEW HYDE PARK, NY
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1776850
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Job Details


Appeals Representative - New Hyde Park, NY(Job Number:726810)
Description

Position Description:
 
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work.

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. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) Agreement.
 
Primary Responsibilities:
  • Ensure complaint has been categorized correctly
  • Determine and confirm member eligibility and benefits
  • Obtain additional documentation required for case review
  • Place relevant documents into image repository
  • Initiate outbound contact to members or providers
  • Render decision for non-clinical complaints using sound, fact-based decision making
  • Draft verbiage for use in outbound correspondence
  • Prioritize and organize tasks to meet compliance deadlines
  • Ability to meet established productivity, schedule adherence, and quality standards
  • Candidate must be willing to work hard and be dedicated to customer service
  • Moderate work experience within own function
  • Some work is completed without established procedures
  • Basic tasks are completed without review by others
  • Supervision / guidance is required for higher level tasks

Job Claims Appeals
Primary Location US-NY-NEW HYDE PARK
Other Location 
Organization O360 Northwell Back Ops
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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