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Supervisor Appeals & Grievance/CTM Quality - Any UHG Office or Current Telecommuter - Full-time / Part-time
| Hours | Full-time, Part-time |
|---|---|
| Location | Tampa, FL Tampa, Florida |
About this job
Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.
Primary Responsibilities:
- Coordinates, supervises and is accountable for the daily activities of team of quality professionals.
- Owns output at task level.
- Sets priorities for the team to ensure task completion.
- Coordinates work activities with other supervisors to ensure production goals are met.
- Develops plans to meet short-term objectives.
- Identifies and resolves operational problems using defined processes, expertise and judgment.
- Decisions are guided by policies, procedures and business plan.
- Builds strong working relationships with Operations Team.
- Use reporting tools to analyze data and identify trends.
- Provides feedback and coaching to team members.
- Tracks performance and addresses performance issues as needed.
- Conducts annual performance reviews for team members.
- Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.
- Impact of work is most often at the team level.
- Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.
- Impact of work is most often at the team level.
- High School Diploma/GED
- Must be available to work Monday-Friday 7am-6pm CST
- 2+ years of experience in a Supervisor, Team Lead, or SME role
- 2+ years of Appeals & Grievance or CTM experience
- 1+ years of experience with Medicare Plans
- Undergraduate Degree or higher preferred
- Project Management experience preferred
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.
Keywords: claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, UnitedHealthcare, training class, customer service representative, customer service, CSR, Data Entry, adjustments, phone support
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