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Senior Appeals Representative - Phoenix, AZ
| Hours | Full-time, Part-time |
|---|---|
| Location | Phoenix, AZ Phoenix, Arizona |
About this job
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.
Flexible?
Friendly? Fast on your feet? That's a great start. Accurate?
Accountable? Self Directed? These traits can take you places. Our claims
operations are the focal point of handling information about services
patients receive and they way those services get paid. It's complex,
detailed work. It's fast paced challenge. It's a job that calls on you
to be thoughtful, resourceful, team-driven and customer-focused. To put
it mildly, there is never a dull moment.
AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people,
you can make a historic impact on the future of health care at
AmeriChoice.
We contract with states and other government
agencies to provide care for over two million individuals. Working with
physicians and other care providers, we ensure that our members obtain
the care they need with a coordinated approach.
This enables us
to break down barriers, which makes health care easier for our
customers to manage. That takes a lot of time. It takes a lot of good
ideas. Most of all - it takes an entire team of talent. Individuals with
the tenacity and the dedication to make things work better for millions
of people all over our country.
You can be a part of this
team. You can put your skills and talents to work in an effort that is
seriously shaping the way health care services are delivered.
Primary Responsibilities:
- Provide
expertise or general claims support by reviewing, researching,
investigating, negotiating and resolving all types of appeals and
grievances - Analyze and identify trends and provides reports as necessary
- Consistently meet established productivity, schedule adherence, and quality standards
- Provide excellent customer service
- Positions
in this function are responsible for providing expertise in reviewing,
researching, investigating, negotiating and resolving all types of
appeals and grievances - Communicate 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 appeals submitted by consumers and
physicians/providers - Process member and regulator appeals by investigating all relevant information and prepare written notification responses
- Complete member and provider appeal cases in specified time frame
- Work with internal departments to resolve appeal cases
- Act as liaison with regulatory agencies regarding member and provider appeals
- Maintain accurate information in database
Requirements
- An education level of at least a High School Diploma or GED
- 2+ years of experience analyzing and solving appeals and grievances
in an office setting environment using the telephone and computer as the
primary instruments to perform job duties - Intermediate proficiency with Microsoft Word, Powerpoint, Outlook and Excel
Physical Requirements and Work Environment:
- Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
Careers with
UnitedHealthcare. Let's talk about opportunity. Start with a
Fortune 17 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 wherever 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.