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

Position Description:Join
a team of the best and brightest to find bold new ways to proactively
improve the health and quality of our member’s lives! You will find a
wealth of dynamic opportunities to grow and develop as we work together
to heal and strengthen our health care system. Join us and start doing your life's best work.The role of a Senior Claims Appeals Coordinator 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 questions and concerns.  As a senior Coordinator, this role is
focused on the processing of their highly complex and unique cases with
minimum assistance.Primary Responsibilities:Acts
as an account manager for assigned Appeals Cases and interacts
extensively with the legal, regulatory affairs and other key internal
stakeholders across Benefit Operations in the member issue resolution
process.  Reviews,
analyzes and processes policies related to claims events to determine
the extent of the company's liability and entitlement. Accountable
for all phases of research and investigation and works with business
partners and/or many different systems across the enterprise to reach
final resolution and remediation.Written
and verbal communication with appropriate parties, including appellant,
regarding appeals and/or grievance issues, implications and decisions
with zero defects and with no grammatical composition and/or punctuation errors.Analyzes and identifies trends and provides reports as necessary.Consistently meets established productivity, schedule adherence, quality standards, and CMS standards.Independently
reviews the member’s appeal or inquiry to determine if
representative/appellant is an authorized party and if complaint is
valid.Prepares case files for internal or external review such as by medical staff or outside entity.Understands both hospital and physician claims types, and can process highly complex and unique cases with minimum assistance.Understands
key HIPPA and CMS requirements and regulatory guidelines, and is fully
competent in applying to daily workflow as evidenced by meeting
Turnaround Times (TAT) for assigned cases, providing accurate case file
decisions and prioritizing workflow on a consistent basis.

Required Qualifications:High School Diploma/GED2+ years of experience in an Appeals and Grievance or Claims role, medical office or health insurerAbility to understand and professionally explain complex medical
information to providers and members in regard to their appeal concernsIntermediate PC
skills (Word/Excel) and keyboarding skills, with previous experience
navigating multiple SharePoint Sites and accessing files to retrieve and
validate data on a consistent basisClaims knowledge and experienceProficient with all HIPPA guidelines Available to
work flexible work schedules and work extended hours including weekend
hours on a consistent basis to meet CMS deadlinesPreferred Qualifications:
Associate's DegreeProficient with CMS regulations for Chapter 13 on appeals processing standardsExperience with healthcare/medical terminology Working knowledge of Medicare Part C claims filing experienceWorking knowledge of Cosmos/Nice platformsProficient in processing adjustmentsExperience working for UnitedHealth Group or United HealthcareSoft Skills:
Proven ability to work independently and  with minimum supervisionExcellent conflict and time management skillsProfessionally and adeptly resolve issues while under stressAbility to meet urgent regulatory timelinesDemonstrate personal resilienceAbility to handle multiple prioritiesDetail oriented, analytical and ability to problem solveExcellent written and oral communication skillsAbility to ask appropriate questions and actively listen to identify underlying questions and issuesAbility to understand and professionally explain complex medical
information to providers and members in regard to their appeal concernsPhysical Requirements and Work Environment:
Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouseCareers 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.SMDiversity
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.