Claim Appeals Coordinator - Cypress, CA - Full-time / Part-time

Claim Appeals Coordinator

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work. SM

The role of an M&R Claims Appeals Coordinator is to serve as a trusted resource in providing problem resolution and support for our Medicare members regarding their  questions on their  health care coverage or payments made on an insurance claim.  This means developing and maintaining member relationships both on the phone and in writing through the process of researching and resolving open issues.

A key requirement of this role is to deal with our members in a compassionate manner – always remembering that there is a real person on the other end of the phone who may not understand their insurance coverage, and is looking for your help and support in navigating the health care system

Responsibilities:

• Receives and reviews the members' initial case file and validates all required information by conducting research or contacting the member directly.  These may include:




• Medical benefits, eligibility and claim payments


• Deductible limits and co-payments


• Pharmacy benefits, eligibility and claims


• Billing and enrollment inquires


• Research and investigate data questions through the use of multiple internal computer databases, external computer systems and supporting technology, such as scanning/imaging.


• Partners  with all service delivery functions ( i.e. clinical, claims, billing and enrollment) to answer member questions/or works with others to resolve escalated issues 


• Develops and delivers timely and professional communication explaining detailed insurance coverage information at each step of the process to advise members of the progress and status of their issue.  (Quality standards means that all correspondence must be error free - no spelling, punctuation, grammatical or other errors.)


• Maintains system documentation on the tracking and monitoring of all cases as well as the final disposition  to ensure overall compliance with Medicare regulations


• Meets established productivity and quality standards in addition to attendance requirements

Requirements:

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


• Minimum 1 year customer service experience with prior experience in healthcare preferred


• Strong computer knowledge (Word/Excel) and keyboarding skills (ability to navigate multiple systems and sites to validate and process information to retrieve data)


• Strong written communication skills including grammatical composition and spelling (ability to write error free letters to translate medical and insurance jargon and complex processes into simple, step-by-step letters that members can understand)


• Available to work flexible work schedules and overtime including weekends on a consistent basis in order to meet deadlines.


• Desire and passion to  improve the life of others by providing outstanding service to our members


• Demonstrated ability to listen skillfully, collect relevant information, and determine next steps to solve the problem


• Flexibility to customize approach to meet all types of member communication styles and personalities


• Excellent conflict  and time management skills including:


• Professionally and adeptly resolve issues while under stress


• Ability to meet urgent regulatory timelines


• Demonstrate personal resilience


• Experience with healthcare/medical terminology strongly preferred


• Authorization to work in the United States

Physical Requirements and Work Environment:

• Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer


• Operations center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

Our hiring process is rigorous – it is rigorous because we want to insure the best job and culture fit for you and for us.  Please insure that your application is complete and that all required sections have been filled out (about you, history and certifications, application questions and job questions.)

You will be sent information regarding the steps to follow in our hiring process via additional e-mail correspondence.  This may include a link for the completion of an on-line pre-selection test.  The test should be taken within 48 hours and can only be retaken after a six month waiting period.  We encourage you to also review our online pre-screening in the event you are requested to complete your interview via this method. Upon successful completion of these steps and a review to determine if your qualifications match the position, you will be advised of your status. 

UnitedHealthcare Medicare & Retirement is the largest business in the nation dedicated to serving the health and well-being needs of individuals 50 and older, the fasters growing market segment for health and well-being services.  It is our mission to provide health services uniquely designed for the preventive, chronic and acute health care needs of our aging population. UnitedHealthcare Medicare & Retirement delivers health and well-being benefits to 9 million seniors in conjunction with AARP across all major product categories in virtually every key U.S. market. UnitedHealthcare Medicare & Retirement has a unique market position because of its multifaceted and national business scope dedicated to senior health care and Medicare, including experience with the frail elderly, the Medicare Supplement business, Medicare health plans, services for individuals with chronic conditions and prescription drug programs.

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.