Claims Appeals Representative - Shavano Park, TX

Reward yourself with a career that will thrive. Apply now for classes
starting soon to reap the benefits of a career with UnitedHealth
Group!

You’re looking for a career where your performance will be rewarded. When
you join UnitedHealthcare’s Appeals Group, you’ll be part of a team committed to
constantly challenging ourselves to improve in key performance areas. Here your
performance will be rewarded as success is expected, measured and rewarded with
increasing opportunities, responsibilities, and performance based pay
incentives. You’ll be empowered to serve members in key markets and geographic
regions with a broad range of health benefit products including
employer-sponsored health plans, members enrolled in Medicare and Medicaid, as
well members who purchase their own health plans. At UnitedHealth Group, you’re
not just a team member. You’re part of an elite, Fortune 6 team that’s equipped
with the best tools and resources, the most thorough training and learning
opportunities and a mission that can inspire you every day to do your life's
best work. (SM)

As
a Claims Appeals Representative, we will depend on you to communicate
some of our most critical information to the correct individuals regarding
appeals and grievance issues, implications and decisions. You will support teams
with reviewing, researching, and understand how a claim was processed and why it
was denied. You will need a high degree of follow through, attention to detail,
and proficiency with verbal and written communication.

This
position is full-time (40 hours/week) Monday - Friday. Employees are required
to have flexibility to work any of our 8 hour shift schedules during our normal
business hours of (7am-6pm). It may be necessary, given the business need, to
work occasional overtime. Our office is located at 4350 Lockhill Selma, San Antonio, TX 78249.
 
Primary Responsibilities:
Review, research and understand how a claim submitted by
consumers and physicians/providers was processed and determine why it was
deniedIdentify and obtain all additional information (relevant
medical records, contract language and process/procedures) needed to make an
appropriate determination of the appeal on the claimMake an appropriate determination about whether a claim should
be approved or denied based on the available information and research           
                              Determine whether additional appeal or grievance reviews are
required and/or whether additional appeal rights are applicable and then if
necessary, route to the proper department for their review and
decision/responseComplete necessary documentation of final   documentation of
final determination of appeals or grievance using the appropriate templates,
communication process, etc. (e.g. response letters, customer service
documentation)Communicate appeal or grievance information to members or
providers with the required timeframes well as to all appropriate internal or
external parties (regulatory agencies, plan administrators, etc.) Meet the performance goals established for the position in the areas of:
efficiency, accuracy, quality, member

Minimum of 1 year work experience in a related environment
(i.e. office, administrative, clerical, customer service, etc.)    
 An education level of at least a high school diploma or GED OR
10 years of equivalent working experienceFamiliarity and fluency with computer and Windows PC
applications, which includes the ability to learn new and complex computer
system applicationsAbility to compose written correspondence free of grammatical
errors while also translating medical and insurance expressions into simple
terms that members can easily understandAbility to remain focused and productive each day though tasks
may be repetitiveAbility to multi-task, including the ability to understand
multiple products and multiple levels of benefits within each
productConsistent attendance with ability to meet work schedule
including the required training periodSuccessful completion of the UnitedHealth Group new hire
training and demonstrated proficiency required
 
Preferred Qualifications:
Previous experience with medical claims processing
preferred
 
There are several steps in our hiring process - it’s a thorough process
because we want to ensure the best job and culture fit for you and for us. In
today’s ultra-competitive job market, the importance of putting your best foot
forward is more important than ever. And you can start by completing all
required sections of your application. (i.e. profile, history, certifications
and application/job questions). Once you submit your resume, you’ll receive an
email with next steps. This may include a link for an on-line pre-screening test
that we ask you to complete as part of our selection process.  You may also be
asked to complete a digital video interview, but we will offer full instructions
and tips to help you. After you have completed all of these steps, you can check
on the status of your application at any time, but you will also be notified via
e-mail. http://uhg.hr/OurApplicationProcessCareers 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.

Keywords: claims,
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representative, customer service, CSR, Data Entry, appeals, dispute resolution,
phone support