Appeals Representative - Wausau, WI

Position Description:
 
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.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 standardsModerate 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.

Required Qualifications:
 

High School Diploma or GED
2+ years medical claims processing experience
1+ 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
Experience creating and modifying documents within Microsoft Word
Experience organizing and maintaining large files within Microsoft Excel and Outlook
Ability to navigate multiple computer systems.
Preferred Qualifications:

Experience with Healthcare/Medical/Pharmacy terminologyExperience working with CPS Claims system
Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.
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.

Keywords:  claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, UnitedHealthcare,  training class, customer service representative, customer service, CSR, Data Entry, appeals, dispute resolution, phone support