Appeals Representative - Baton Rouge, Louisiana - Full-time / Part-time

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.SM

Primary Responsibilities:

• Ensure complaint has been categorized correctly


• Determine and confirm member eligibility and benefits


• Obtain additional documentation required for case review


• Place relevant documents into image repository


• Initiate outbound contact to members or providers


• Review case to determine if review by Clinician is required


• Research and resolve written complaints submitted by consumers and physicians/providers


• Render decision for non-clinical complaints using sound, fact-based decision making


• Draft verbiage for use in outbound correspondence


• Prioritize and organize tasks to meet CMS compliance deadlines


• Ability to meet established productivity, schedule adherence, and quality standards

Requirements:

• An education level of at least a high school diploma or GED OR 10 years of equivalent working experience


• 1+ year of customer service experience analyzing and solving customer problems; OR 1+ year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties required


• Proficiency in MS Office applications (Word, Excel & Outlook) is required


• Experience with Healthcare/Medical/Pharmacy terminology highly preferred


• Strong customer service orientation


• Strong communication/telephone skills


• Sound decision making skills


• Ability to navigate multiple computer systems.

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 14 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: 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.