Sign In
 [New User? Sign Up]
Mobile Version

Appeals Representative - Shavano Park, TX and Columbus, OH

UnitedHealth Group

Shavano Park-Texas, TX
Job Code:
Apply on the Company Site
  • Save Ad
  • Email Friend
  • Print

Job Details

735704 Appeals Representative Shavano Park TX

Appeals Representative - Shavano Park, TX and Columbus, OH (735704)

Position Description

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 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 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
  • Review case to determine if review by clinician is required
  • Research and resolve written complaints submitted by consumers and physicians / 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
  • 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
Required Qualifications:
  • High School Diploma or GED
  • 1+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
  • Basic proficiency with Microsoft Word (open and 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 needed
Preferred Qualifications:
  • 1+ years of claims / billing experience
  • Medical Billing / Coding Certificate
  • Intermediate data entry experience
  • Experience using any of the following claims platforms: UNET, COSMOS, CPW, ISET, NICE, FACETS, Diamond, CSP and / or Unison
Soft Skills:
  • Strong customer service orientation
  • Strong communication skills
  • Sound decision making skills
  • Ability to navigate multiple computer systems
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 opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to 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, Columbus, OH

Job Details

  • Contest Number735704
  • Job TitleAppeals Representative - Shavano Park, TX and Columbus, OH
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - MandR Ops

Job Location Information

  • Shavano Park-Texas, TX
    United States
    North America
  • Other LocationsColumbus, OH

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

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.

Powered ByLogo

Featured Jobs[ View All ]

Featured Employers [ View All ]