Senior Claims Appeals Representative - Shelton, CT - Full-time / Part-time

Grow your career with an industry leader! We have training classes starting soon. Apply now!Are you the person your friends and family go to when they need advice or a listening ear?  In this fast growing healthcare industry, UnitedHealth Group is searching for those individuals who can serve as a trusted resource to our members.  You can be a part of the brightest and best team that are leading the way in improving the health and quality of life for our rapidly expanding customer base.  Compassion is at the center of your life’s best work. (SM)As a Senior Claims Appeals Representative, you will compassionately interact with our members - remembering there is a real person on the other side of the call who may not understand their insurance coverage and is looking to you for help with navigating through their plan and their healthcare claims. Your role is to provide problem resolution and support to our members concerning their complex appeals or grievances related to their coverage or claims.  In order to do so, you will be expected to develop and maintain positive member relationships via telephone and written communication. Primary Responsibilities:Serve as a resource or Subject Matter Expert (SME) for other team members or internal customersHandle escalated claims, drawing on experience and knowledge to resolve more complex customer issuesConducts research utilizing multiple internal computer databases and external systems on each case file to determine if the member making the appeal (or representative) is authorized and that the complaint is valid including situations such as benefits eligibility, claim payments, deductible limits and copayments, prescription benefits eligibility, and billing or enrollment inquiriesDetermines whether a case requires multiple complaint records; assigns classifications to each recordDelivers timely and professional communication via telephone or email to members with complex issues for each step of the process, notifying the member the progress and status of their issue; meet expected turnaround times for each assigned casePartner with other departments (i.e. clinical, claims, billing, etc.) to gather additional information in order to answer member questions or to resolve escalated issuesInput and maintain documentation to track and monitor progress of all cases as well as the final result to ensure overall compliance; apply key HIPPA guidelines in daily activitiesServe as a resource or Subject Matter Expert (SME) for other team members or internal customers

Required
Qualifications:Minimum 1 year Customer Service Representative (CSR) experience or 1 year
experience in an office setting, call center setting or phone support roleAn education level of at least a high school diploma or GED OR 10 years of
equivalent working experienceDemonstrated ability in using
computer and Windows PC applications, which includes strong keyboard and
navigation skills and learning new computer programs Ability
to compose written correspondence free of grammatical errors while also
translating medical and insurance expressions into simple terms that members
can easily understandAbility to remain focused and productive each day though tasks may be
repetitiveAbility to multi-task, including the ability to understand multiple products
and multiple levels of benefits within each productConsistent attendance with ability to meet work schedule including the required
training periodSuccessful completion of the UnitedHealth Group new hire training and demonstrated
proficiency required

Preferred Qualifications:Previous experience with medical claims processing preferredThere are several steps in our hiring process - it’s a thorough process because we want to ensure the best job and culture fit for you and for us. In today’s ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you’ll receive an email with next steps. This may include a link for an on-line pre-screening test that we ask you to complete as part of our selection process.  You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail. http://uhg.hr/OurApplicationProcessCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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: 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: Insurance, customer service, customer service representative, claims, appeals, call center, phone support, dispute resolution, healthcare, UnitedHealthcare, UnitedHealth Group