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Senior Grievance Coordinator - Dublin, OH

UnitedHealth Group

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Job Details

736932 Senior Grievance Coordinator Dublin OH

Senior Grievance Coordinator - Dublin, OH (736932)

Position Description

Grow your career with an industry leader! We have training classes starting soon. now!
Are you the person your friends and family go to when they need advice or a listening ear?  In this fast growing healthcare industry, UnitedHealth Group is searching for those individuals who can serve as a trusted resource to our members.  You can be a part of the brightest and best team that are leading the way in improving the health and quality of life for our rapidly expanding customer base.  Compassion is at the center of your life’s best work. (SM)

As a Senior Grievance Coordinator, your role is to provide support to our members by investigating and responding to their written grievances (complaints) related to their experiences with UnitedHealth Group. You will review the available information and connect with members by email and phone as needed for missing details. You will be expected to develop and maintain positive member relationships via telephone and written communication.

This position is full-time (40 hours/week) with flexible scheduling options during the available shift hours of 7:00 am - 6:00 pm Monday through Friday. It may be necessary, given the business needs, to work occasional overtime. Our office is located at 5900 Parkwood Place, Dublin OH 43016.

Primary Responsibilities:
  • Handles escalated member grievances, drawing on experience and knowledge to resolve more complex customer issues
  • Conducts research utilizing multiple internal computer databases and external systems on each case file to determine if the member grieving (or representative) is authorized and that the complaint is valid including situations such as benefits eligibility, claim payments, deductible limits and copayments, prescription benefits eligibility, and billing or enrollment inquiries
  • Determines whether a case requires multiple complaint records; assigns classifications to each record
  • Outbound calls to Providers and Members to resolve missing or discrepant information
  • Delivers timely and professional communication via telephone or email to members with complex issues for each step of the process, notifying the member of the progress and status of their issue; meet expected turnaround times for each assigned case
  • Document outcome to member in written correspondence, communicating the outcome both clearly and concisely.
  • Partner with other departments (i.e. clinical, claims, billing, etc.) to gather additional information in order to answer member questions or to resolve escalated issues
  • Input and maintain documentation to track and monitor progress of all cases as well as the final result to ensure overall compliance; key HIPPA guidelines in daily activities

Required Qualifications:
  • A minimum education level of a high school diploma/GED; OR at ten years of equivalent working experience
  • Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
  • Demonstrated proficiency in using Microsoft Office (Outlook, Word & Excel) to complete work assignments
  • Ability to compose written correspondence free of grammatical errors while also translating medical and insurance expressions into simple terms that members can easily understand
  • Consistent attendance with ability to meet work schedule including the required training period
  • Ability to skillfully listen, gather the necessary information, determine next steps or resolution while meeting urgent regulatory timelines and remaining calm regardless of the members disposition or complexity of the issue
  • Successful completion of the UnitedHealth Group new hire training and demonstrated proficiency required

Preferred Qualifications:
  • 1 year of experience processing healthcare claims
  • Experience analyzing and solving appeals and/or grievances preferred
  • Demonstrated understanding of key HIPPA requirements and regulatory guidelines
There are several steps in our hiring process - it’s a thorough process because we want to ensure the best job and culture fit for you and for us. In today’s ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you’ll receive an email with next steps. This may include a link for an on-line pre-screening test that we ask you to complete as part of our selection process.  You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail.

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.

Keywords: Insurance, customer service, customer service representative, claims, appeals, call center, phone support, dispute resolution, healthcare, UnitedHealthcare, UnitedHealth Group

Job Details

  • Contest Number736932
  • Job TitleSenior Grievance Coordinator - Dublin, OH
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - MandR Ops

Job Location Information

    United States
    North America
  • Other LocationsColumbus, OH

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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