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Manager Appeals - Cypress, CA

UnitedHealth Group


Location:
Cypress, CA
Date:
04/28/2017
Job Code:
1739343
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Job Details


Manager Appeals - Cypress, CA(Job Number:709395)
Description

Position Description:

You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.(sm)

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:

  • Knowledge of CMS regulatory guidelines (i.e. Chapters 13 and 18). Works with Compliance/ Regulatory Affairs and Legal teams that support the Government business units for interpretation of guidelines to resolve member appeal issues
  • Strong understanding of benefit operations functional areas that have an upstream/downstream impact
  • Develop working relationships with internal business partners for problem resolution purposes
  • Works closely with Legal, Compliance and Regulatory Affairs
  • Identify process gaps and lead process improvement activities
  • Proactively manage inventory, overtime, and throughput

 

 


Job Claims Appeals
Primary Location US-CA-Cypress
Other Location 
Organization M&R Ops - M&R Appeals
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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