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C&S Appeals Representative (Triage) - Phoenix, AZ

UnitedHealth Group


Location:
Phoenix, AZ
Date:
12/08/2017
2017-12-082018-01-06
Job Code:
739194
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Job Details

739194 CS Appeals Representative Triage Phoenix AZ

C&S Appeals Representative (Triage) - Phoenix, AZ (739194)

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.

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed.

Responsible for providing expertise or general support to teams in reviewing, researching, investigating all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues. Analyzes and identifies trends for all appeals and grievances. May research written Department of Insurance complaints and complex or multi - issue provider complaints submitted by consumers and physicians / providers.

Primary Responsibilities:
  • Enter provider or member submission into appeal data base
  • Ensure submission has been categorized correctly
  • Determine and confirm member eligibility and benefits
  • Place relevant documents into image repository
  • Initiate outbound contact to members or providers
  • Review case to determine if review by Clinician is required
  • 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
  • Work less complex special projects
  • Basic tasks are completed without review by others
  • Supervision / guidance is required for higher level tasks
  • Ensure all incoming receipts are processed within required time frames to meet performance guarantees
  • Participate in meetings to share, discuss, and solution for question or error trends, as well as potential process improvements
  • Identify issue trends affecting multiple areas and escalate to appropriate partners
  • Participate in individual coaching sessions as requested by management
  • Attend group training sessions as requested by management
Required Qualifications:
  • High School Diploma / GED (or higher)
  • 6+ months of experience working with a computer and windows PC applications with the ability to learn new computer systems quickly
  • Must be a resident of Arizona
  • Ability to work flexible 8 hours between from 7:00 am - 5:00 pm Monday through Friday and able to work overtime and weekend hours as business needs dictate
Preferred Qualifications:
  • 1+ years of claims processing experience or experience in analyzing and solving appeals & grievances
  • Knowledge in utilizing Cosmos and / or Facets (RV, Unison or CSP) claim platforms
  • Experience with healthcare / medical terminology
Soft Skills:
  • Ability to complete acknowledgement letter writing utilizing appropriate grammar
  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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: data entry, scanning, appeals, support, grievances

Job Details

  • Contest Number739194
  • Job TitleC&S Appeals Representative (Triage) - Phoenix, AZ
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - CandS Ops

Job Location Information

  • Phoenix, AZ
    United States
    North America

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.

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