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Senior Appeals Representative - Cypress, CA

UnitedHealth Group


Location:
Cypress, CA
Date:
01/19/2018
2018-01-192018-02-17
Job Code:
744308
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Job Details

744308 Senior Appeals Representative Cypress CA

Senior Appeals Representative - Cypress, CA (744308)

Position Description

Position Description:

Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how United Health Group became a Fortune 6 leader in healthcare. We did it by working to become an undisputed leader in creating service quality and helping to improve the lives of millions. Now, here’s where you come in. You can build on your problem solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You’ll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we’ll provide you with great training, support and opportunities.

This is a challenging role with serious impact. You’ll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. You’ll act as a subject matter expert for your team on applicable regulatory guidelines and privacy policies. You’ll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member.

Primary Responsibilities
  • Research and resolve written complaints submitted by consumers and physicians/providers
  • Ensure complaint has been categorized correctly
  • Obtain additional documentation required for case review
  • Review case to determine if review by clinician is required
  • Render decision for non-clinical complaints using sound, fact-based decision making
  • Complete necessary documentation of final appeals or grievance determination using appropriate templates
  • Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes

Required Qualifications

  • 1+ year of case installation experience
  • Knowledge of claims processing systems, guidelines and processes
  • Intermediate Excel skills (formulas, edit/create spreadsheet)
  • High school diploma, GED
  • Must be available Tue-Sat during the operating hours of the site with the flexibility to adjust   daily schedule, and work over-time and/or weekends, as needed

                                           

Preferred Qualifications

  • Experience working with medical claims platforms
  • An undergraduate degree or higher
  • UNET experience

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.SM


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.


Key Words: Healthcare, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing

 

Job Details

  • Contest Number744308
  • Job TitleSenior Appeals Representative - Cypress, CA
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - MandR Ops

Job Location Information

  • Cypress, CA
    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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