Regulatory Appeal Analyst - Cypress, CA - Full-time / Part-time

Position Description:

 

You'll join a high caliber team
where you're assisting, educating, problem-solving and resolving tenuous
situations to the best possible outcomes. Bring your people skills, emotional
strength and attention to detail. Get ready to start doing your life's best
work.

 

Primary Responsibilities:

Investigate, retrieve and resolve all types of appeal
and grievance issues as well as recovery and resolution of complaint
issues for the health plan's, commercial customers and government entities.
May include initiating telephone calls to state
regulators, members, providers and other insurance companies to gather
coordination of benefits data. Investigate and pursue the effectuation of recoveries
and payables on subrogation claims and file management.Ensure the process recovery of member and provider
claims. Ensure plan and contracted provider's adherence to
state and federal compliance policies, reimbursement policies and contract
compliance. Monitor the effectuation of appropriate claims.Complete other duties as assigned by managerReview the process and application of member benefit
issues.Serves as an individual contributor.

Requirements:

Bachelor's Degree OR 3+ years of equivalent experienceIntermediate complex writing skillsIntermediate analytical skillsAbility to perform complex research3+ years of Healthcare Appeals experience

Assets: 

Experience with regulatory Appeals a plus, but not
required

Soft Skills:

Flexibility (process and/or system changes)

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.

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.