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Senior Appeals Representative - Oldsmar, FL

UnitedHealth Group


Location:
Oldsmar, FL
Date:
11/17/2017
2017-11-172017-12-16
Job Code:
738175
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Job Details

738175 Senior Appeals Representative Oldsmar FL

Senior Appeals Representative - Oldsmar, FL (738175)

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.

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
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.
Required Qualifications

  • High school diploma or GED OR equivalent work experience
  • Strong written communication skills including advanced skills in grammar and spelling
  • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
  • Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product

Preferred Qualifications

  • 2+ years of experience analyzing and solving appeals and grievances in an office environment using the telephone and computer as the primary instruments to perform job duties OR 2+ years of experience in a healthcare setting with knowledge of the medical claims and/or billing process

UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life’s best work.SM

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


Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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.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.

Job Details

  • Contest Number738175
  • Job TitleSenior Appeals Representative - Oldsmar, FL
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - MandR Ops

Job Location Information

  • Oldsmar, FL
    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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