Appeals Representative - Oldsmar, FL - Full-time / Part-time

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:

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 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/GED 1+ years of experience in healthcare field 1+ years of experience working with Microsoft Word, Excel and Outlook 1+ years of experience working with Adobe Available to work flexible work schedules and overtime including weekends on a consistent basis in order to meet deadlines.Assets:Associate's Degree Physical Requirements and Work EnvironmentFrequent 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 Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to 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.