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Senior Appeals Representative - Dublin, OH

UnitedHealth Group


Location:
DUBLIN, OH
Date:
04/19/2018
2018-04-192018-05-18
Job Code:
759379
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Job Details

759379 Senior Appeals Representative Dublin OH

Senior Appeals Representative - Dublin, OH (759379)

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.

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:
  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances
  • Analyze and identify trends and provides reports as necessary
  • Consistently meet established productivity, schedule adherence, and quality standards
  • Provide excellent customer service
  • Extensive work experience within own function
  • Work is frequently completed without established procedures
  • Works independently
  • May act as a resource for others
  • May coordinate others' activities

Required Qualifications:

  • High School Diploma / GED or higher

  • 1+ years of Customer Service experience analyzing and solving customer's problems OR 2+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties

  • 1+ years of experience in Microsoft Word (creating and editing documents), Microsoft Excel (maintain spreadsheets, filter, and organize data), and Microsoft Outlook (emails, and calendar invites)

  • Available to work between the hours of 7:00 am and 7:00 pm with the availabilty for overtime and weekends as required

Preferred Qualifications:

  • Experience with Healthcare, Medical, and Pharmacy Terminology

  • Experience working with Cosmos, NICE, or UNet (ability to look up claims)

  • Experience working with claims and adjustments

Soft Skills:

  • Strong customer service orientation

  • Strong communication / telephone skills

  • Sound decision making skills

  • Ability to navigate multiple computer systems

Physical Requirements and Work Environment:

  • Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse

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.


Keywords: Insurance, customer service, customer service representative, claims, appeals, dispute resolution, healthcare, UnitedHealthcare, UnitedHealth Group, Senior Appeals Representative, NICE, UNet, Cosmos, Dublin, OH

Job Details

  • Contest Number759379
  • Job TitleSenior Appeals Representative - Dublin, OH
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - MandR Ops

Job Location Information

  • DUBLIN, OH
    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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