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Senior Claims Appeals Representative - Oldsmar, FL - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Oldsmar, FL Oldsmar, Florida |
About this job
The role of an M&R Senior Claims Appeals Representative is to serve as a trusted resource in providing problem resolution and support for our Medicare members regarding their complex appeals or grievances related to their coverage or claims. This means developing and maintaining member relationships both on the phone and in writing through the process of researching and resolving their complex questions and concerns. As a Senior Coordinator, this role is focused on the processing of highly complex and unique cases with minimum assistance.
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:
- Independently reviews the members' case file to determine if representative/appellant is authorized party and if complaint is valid. These may include:
- Medical benefits, eligibility and claim payments
- Deductible limits and co-payments
- Pharmacy benefits, eligibility and claims
- Billing and enrollment inquires
- Demonstrates proficiency in determining if case requires creation of multiple complaint records and reviews correspond to determine classification and sub-type.
- Prioritizes workflow on a consistent basis, applies key HIPPA and CMS guidelines in daily workflow, and meets Turnaround Times for assigned cases.
- Research and investigate complex issues 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 dealing with complex issues 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
Requirements:
- An education level of at least a high school diploma or GED
- Minimum 1 year customer service experience
- Strong computer knowledge and keyboarding skills
- Strong written communication skills
Assets:
- Experience working for UnitedHealth Group or UnitedHealthcare preferred
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 fastest 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.
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