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Claims Appeal Analyst - La Palma, CA

UnitedHealth Group

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Job Details

Claims Appeal Analyst - La Palma, CA(Job Number:730631)

Flexible, Friendly, Fast on your feet, that's a great start. Accurate, Accountable, Self Directed, These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. Claims Appeal Analysts are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses / planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.

Primary Responsibilities:

  • Responsible for providing research and root cause analysis for claim quality remediation

  • Perform capacity planning and reporting

  • Responsible for all aspects of quality assurance

  • Create and edit requirements, specifications, cost benefit analysis and recommendations to proposed solutions

  • Facilitate development of process documentation

  • Follow standard programming guidelines and requirements as set by team

  • Standard documentation and tracking processes

  • Uses pertinent data and facts to identify and solve a range of problems within area of expertise

  • To review and process provider disputes and appeals as established in the Claims Department Policies and Procedures

  • To process appeals and provider disputes pursuant to designated production quotas for accuracy and productivity benchmark

  • Respond to claims appeals and disputes in a timely manner

  • Research health plan demands and communicate back to the health plans

  • Track disputes and adjustments to monitor compliance

  • Generate, track and monitor claims overpayment and recovery

  • Serve as a resource to claims auditing when needed

  • To contribute to a fair and positive work environment by treating peers, superiors, subordinates, clients, and vendors with professionalism and respect

  • To perform other duties as directed

Job Claim Business Process
Primary Location US-CA-LA PALMA
Other Location 
Organization AppleCare
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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