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Appeals Representative - Wausau, WI - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Wausau, WI Wausau, Wisconsin |
About this job
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.
UnitedHealth Group is working to create the health care system of tomorrow.
Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed.
Positions in this function are responsible for reviewing, researching, investigating, and triaging all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues.
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 compliance deadlines
- Ability to meet established productivity, schedule adherence, and quality standards
Requirements
Requirements:
- High school diploma or GED
- 1+ year of customer service experience analyzing and solving customer problems
- Basic proficiency in MS Word & Excel is required
- Ability to navigate multiple computer systems
Preferred experience:
- Basic proficiency in MS Outlook is a plus
- Experience with Healthcare/Medical/Pharmacy terminology highly preferred
- Associate's degree or higher preferred
- 6 months+ experience with CPS (UMR Claim Processing System)
- 2+ years claims processing experience
Soft Skills:
- Strong written/verbal communication
Take the next step, online at: www.yourlifesbestwork.com
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.
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.
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