The Job — Claims Appeal Representative for UnitedHealth
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
- 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.