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Claims Appeals Representative - Brentwood, TN
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Brentwood, TN Brentwood, Tennessee |
About this job
Position Description:
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 standards
- Moderate 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
Requirements:
Careers 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.
- An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
- 1+ years customer service experience with prior experience in healthcare preferred
- Basic Proficiency in Microsoft Word, Excel and Outlook and keyboarding skills (ability to navigate multiple systems and sites to validate and process information to retrieve data)
- Standard working hours are 8am - 4:30pm Monday - Friday. Must be flexible to work overtime as needed.
- Authorization to work in the United States
- Experience with healthcare/medical terminology strongly preferred
Careers 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.