Appeals Representative - Cypress, CA

Position Description:

UnitedHealth
Group is working to create the health care system of tomorrow and you can help.
Already Fortune 17, 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 healthcare 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. Join with us and
start doing your life's best work. SM

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 CMS compliance deadlines Ability to meet established productivity, schedule adherence, and quality standards

Required Qualifications:  High School Diploma/GED OR 10+ years of equivalent working experience1+ year of customer service experience analyzing and solving customer problems; OR 1+ year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties

Intermediate proficiency in Microsoft Office applications (Word,
Excel & Outlook)

Preferred Qualifications:Experience with Healthcare/Medical/Pharmacy terminologySoft Skills:  Strong customer service orientationStrong communication/telephone skillsSound decision making skillsAbility to navigate multiple computer systems.

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.SM

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.