Appeals Representative - Brentwood, TN; Miami, FL; San Antonio,TX; Richardson, TX; Baltimore, MD; Phoenix, AZ; Baton Rouge, LA ; Sugar Land, TX; Ridgeland, MS

Position Description: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.Positions in this function are responsible for providing
expertise or general support to teams in reviewing, researching,
investigating, negotiating and resolving all types of appeals and
grievances. Communicates with appropriate parties regarding appeals and
grievance issues, implications and decisions. Analyzes and identifies
trends for all appeals and grievances. May research and resolve written
Department of Insurance complaints and complex or multi-issue provider
complaints submitted by consumers and physicians/providers.Primary Responsibilities:
Enter provider or member submission into appeal data baseEnsure submission is categorized correctlyDetermine and confirm member eligibilityPlace relevant documents into image repositoryReview case to determine if review by Clinician is requiredDraft verbiage for use in outbound correspondence with excellent grammarPrioritize and organize tasks to meet compliance deadlinesAbility to meet established productivity, schedule adherence, and quality standardsModerate work experience within own function.Some work is completed without established procedures.Basic tasks are completed without review by others.Supervision/guidance is required for higher level tasks.

Requirements:
High School Diploma or GEDIntermediate proficiency with MS Word, Excel and OutlookAssets:
Experience with Healthcare, Medical and/or Pharmacy terminologySoft Skills:
Sound decision making skillsAbility to navigate multiple computer systems.Ability to follow SOPsAbility to work independentlyCareers 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.Keyword: Iowa2015