Appeals Representative - Brentwood , TN; Franklin, TN

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+ years customer service experience with prior experience in healthcare preferred


• Basic Proficiency in Microsoft Word, Excel and Outlook and keyboarding skills (ability to navigate multiple systems and sites to validate and process information to retrieve data)


• Standard working hours are 8am - 4:30pm Monday - Friday. Must be flexible to work overtime as needed.


• Authorization to work in the United States

Assets:

• Experience with healthcare/medical terminology strongly preferred

Soft Skills:

• 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


• 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)


• Excellent conflict and time management skills including:




• Professionally and adeptly resolve issues while under stress


• Ability to meet urgent regulatory timelines


• Demonstrate personal resilience

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. 

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 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 wherever 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.

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.