Appeals Representative - Oldsmar, FL - Full-time / Part-time

Position Description:  

 

Join a team of the best and
brightest to find bold new ways to proactively improve the health and quality
of our member’s lives! You will find a wealth of dynamic opportunities to grow
and develop as we work together to heal and strengthen our health care system.
Bring along your passion and start do your life's best work. SM 

 

The role of an Appeals Coordinator
is to serve as a trusted resource in providing problem resolution and support
for our Medicare members regarding their appeals or grievances related to their
coverage or claims.  This means
developing and maintaining member relationships both on the phone and in
writing through the process of researching and resolving their questions and
concerns.  As a Coordinator, this role is focused on the validation and
processing of their appeal cases with minimum assistance. 

 

Primary Responsibilities:  

Acts as an account manager for assigned Appeals Cases
and interacts with key internal stakeholders across Benefit Operations in
the member issue resolution process   Reviews,
analyzes and processes policies related to CMS guidelines to determine the
validity of the appeal and need for appropriate documentation, action and
outreachAccountable for research and investigation and works
with business partners and/or many different systems across the enterpriseWritten and verbal communication with appropriate
parties, including appellant, regarding appeal issues and decisions with
zero defects and with no grammatical
composition and/or punctuation errors Consistently meets established productivity, schedule
adherence, quality standards, and CMS standardsUnderstands key HIPPA and CMS requirements and
regulatory guidelines, and is fully competent in applying to daily
workflow as evidenced by meeting Turnaround Times (TAT) for assigned
cases, providing accurate case file decisions and prioritizing workflow on
a consistent basis.

Required Qualifications:



High
School Diploma or GEDWork Shift 8:00 am - 5:00 pm Monday-Friday; overtime as needed on
the weekendsProficiency with Microsoft Excel (ability to produce spreadsheets, use formula's, and maneuver in spreadsheets)Proficiency with Microsoft Word (ability to type letters and use spell check)Advanced
keyboarding skills (40-50 WPM)Proficient with all HIPPA guidelines

Preferred Qualifications:  

Associate's DegreeProficient with CMS regulations for Chapter 13 on
appeals processing standardsExperience with healthcare/medical terminology Experience working for UnitedHealth Group or United
Healthcare

Soft Skills:  

Proven ability to work independently and  with
minimum supervisionExcellent conflict and time management skillsProfessionally and adeptly resolve issues while under
stressAbility to meet urgent regulatory timelinesDemonstrate personal resilienceAbility to handle multiple prioritiesAbility
to ask appropriate questions and actively listen to identify underlying
questions and issues (root cause analysis)Experience
maneuvering through multiple systems to access files to retrieve and
validate data

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 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.SM
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.