Claims Appeal Representative for UnitedHealth

The Job —  Claims Appeal Representative for UnitedHealthcheck-list2

Location —  Telecommute available

Job Responsibilities —  From the Careerbuilder job posting:

  • Review, research and understand how a claim submitted by consumers and physicians/providers was processed and determine why it was denied
  • Identify and obtain all additional information (relevant medical records, contract language and process/procedures) needed to make an appropriate determination of the appeal on the claim
  • Make an appropriate determination about whether a claim should be approved or denied based on the available information and research
  • Determine whether additional appeal or grievance reviews are required and/or whether additional appeal rights are applicable and then if necessary, route to the proper department for their review and decision/response
  • Complete necessary documentation of final   documentation of final determination of appeals or grievance using the appropriate templates, communication process, etc. (e.g. response letters, customer service documentation)
  • Communicate appeal or grievance information to members or providers with the required timeframes well as to all appropriate internal or external parties (regulatory agencies, plan administrators, etc.)
  • Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member

Requirements/Qualifications

  • Minimum of 1 year work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.)
  • An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
  • Familiarity and fluency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
  • Ability to compose written correspondence free of grammatical errors while also translating medical and insurance expressions into simple terms that members can easily understand
  • Ability to remain focused and productive each day though tasks may be repetitive
  • Ability to multi-task, including the ability to understand multiple products and multiple levels of benefits within each product
  • Consistent attendance with ability to meet work schedule including the required training period
  • Successful completion of the UnitedHealth Group new hire training and demonstrated proficiency required

Schedule —  Full time, flexible

Employee or Contract — Employee

Compensation — Not advertised — click here for Glassdoor salary reviews.

Benefits — Full benefits package offered.

More Information — Review and apply via Careerbuilder.