Expedited Senior Claims Appeals Representative - Oldsmar, FL

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Are you the person your friends and family go to when
they need advice or a listening ear?  In
this fast growing healthcare industry, UnitedHealth Group is searching for
those individuals who can serve as a trusted resource to our members.  You can be a part of the brightest and best
team that are leading the way in improving the health and quality of life for
our rapidly expanding customer base. 
Compassion is at the center of your life’s best work. (SM)

As an Expedited Senior Claims Appeals Representative, you
will compassionately interact with our members - remembering there is a real
person on the other side of the call who may not understand their insurance
coverage and is looking to you for help with navigating through their plan and
their healthcare claims.  Your role is to
provide problem resolution and support to our members concerning their complex
appeals or grievances related to their coverage or claims.  In order to do so, you will be expected to
develop and maintain positive member relationships via written communication
and some telephone.

This position is full-time (40 hours/week) Sunday - Saturday.
Employees are required to have flexibility to work any of our 8 hour shift
schedules during our normal business hours of (6am -8pm). It may be necessary,
given the business need, to work occasional overtime or weekends. Our office is
located at 601 Brooker Creek Blvd, Oldsmar, FL 34677.What are the reasons to consider working for UnitedHealth Group?  
Put it all together - competitive base pay, a full and comprehensive benefit
program, performance rewards, and a management team who demonstrates their
commitment to your success.   
Some
of our offerings includes:

18 days of Paid Time Off which you start to accrue with your
first pay period plus 8 Paid HolidaysMedical Plan options along with participation in a Health
Spending Account or a Health Saving accountDental, Vision, Life& AD&D Insurance along with
Short-term disability and Long-Term Disability coverage401(k) Savings Plan, Employee Stock Purchase PlanEducation Reimbursement - up to $5,250 per calendar year for
job-related courseworkAssistance PlanEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary Benefits (pet insurance, legal insurance, LTC
Insurance, etc.)More information can be downloaded at: http://uhg.hr/uhgbenefits 

Primary Responsibilities:

Serve as a resource or Subject Matter Expert (SME) for
other team members or internal customersHandle escalated claims, drawing on experience and
knowledge to resolve more complex customer issuesConducts research utilizing multiple internal
computer databases and external systems on each case file to determine if the
member making the appeal (or representative) is authorized and that the
complaint is valid including situations such as benefits eligibility, claim
payments, deductible limits and copayments, prescription benefits eligibility,
and billing or enrollment inquiriesDetermines whether a case requires multiple complaint
records; assigns classifications to each recordDelivers timely and professional communication via mail,
email or telephone  to members with
complex issues for each step of the process, notifying the member the progress
and status of their issue; meet expected turnaround times for each assigned
casePartner with other departments (i.e. clinical, claims,
billing, etc.) to gather additional information in order to answer member
questions or to resolve escalated issuesInput and maintain documentation to track and monitor
progress of all cases as well as the final result to ensure overall compliance;
apply key HIPPA guidelines in daily activities

Required Qualifications:Minimum of 6-12 months of experience working in healthcare, pharmacy, customer service AND/OR processing healthcare claimsA minimum education level of a high school diploma/GED; OR at ten years of equivalent working experienceDemonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs Demonstrated proficiency in using Microsoft Office (Outlook, Word & Excel) to complete work assignmentsDemonstrated understanding of key HIPPA requirements and regulatory guidelinesAbility to compose written correspondence free of grammatical errors while also translating medical and insurance expressions into simple terms that members can easily understandConsistent attendance with ability to meet work schedule including the required training periodAbility to skillfully listen, gather the necessary information, determine next steps or resolution while meeting urgent regulatory timelines and  remaining calm regardless of the members disposition or complexity of the issueAbility to think critically, reviewing highly sensitive personal health information while being extremely detail-oriented in creating responses to appeals Successful completion of the UnitedHealth Group new hire training and demonstrated proficiency requiredThere 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 6 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:
Insurance, customer service, customer service representative, claims, appeals,
call center, phone support, dispute resolution, healthcare, UnitedHealthcare,
UnitedHealth Group