Appeals Representative - Knoxville,TN - Full-time / Part-time

Position Description:

Welcome
to one of the toughest and most fulfilling ways to help people,
including yourself. We offer the latest tools, most intensive training
program in the industry and nearly limitless opportunities for
advancement. Join us and start doing your life's best work.

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.

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
• Moderate work experience within own function.
• Some work is completed without established procedures.
• Basic tasks are completed without review by others.
• Supervision/guidance is required for higher level tasks.
  

Requirements:

• High School Diploma/GED Required
• 1+ year medical claims processing knowledge and an
  understanding of medical terminology (i.e. familiarity with ICD-9 and
  CPT codes and other medical codes as well)
• Knowledge of Medicaid is required
• Familiarity utilizing and having access to the River
  Valley (RV) Facets platforms; i.e. customer service, quality, claims
  processing, etc
• Familiarity utilizing and having access to the Macess Facets platform; i.e. customer service, quality, claims processing, etc.
• Basic familiarity with Microsoft Word and Excel is required (Word – creating and editing Word documents; Excel – creating simple spreadsheets, filtering/sorting, etc.)
• Must have the ability to work overtime as business needs required

Assets:

• Previous appeals/grievances experience is preferred
• 1+ year of adjustment processing experience preferred

UnitedHealthcare, part of the UnitedHealth Group
family of companies, is comprised of three specialized businesses
dedicated to meeting the health care benefits needs of individuals and
groups; all part of something greater, but each with a specialized
focus:

UnitedHealthcare
Employer & Individual works with individuals, small businesses and
large multi-site employers to provide innovative, affordable benefits
services.

UnitedHealthcare
Medicare & Retirement is focused on serving Americans over the age
of 50. It is the largest business dedicated to meeting the growing
health and well-being needs of aging individuals in the nation, serving
one in five Medicare beneficiaries through a comprehensive and
diversified array of products and services through four industry-leading
businesses.

UnitedHealthcare
Community & State provides high-quality, personalized,
public-sector health care programs that help local government agencies
improve health outcomes for millions of children and low-income and
disabled individuals at an affordable cost.

Together,
we're removing the barriers that keep people from receiving the kind of
quality health care that makes a difference. We focus on Integrity,
Compassion, Relationships, Innovation and

Performance as we empower people to achieve better health and well-being.

Come grow
and thrive in our culture of innovation and ideas. Because there is no
opportunity greater than the quest to help people live healthier lives.

Diversity
creates a healthier atmosphere: All qualified applicants will receive
consideration for employment without regard to race, color, religion, sex,
national origin, protected veteran status, or disability status. 

UnitedHealth
Group
is a drug-free workplace. Candidates are required to pass a drug test before
beginning employment. In addition, employees in certain positions are subject
to random drug testing.