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Hours Full-time, Part-time
Location Cypress, CA
Cypress, California

About this job

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 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. Employees in jobs labeled with SCA
must support a government Service Contract Act (SCA) agreement.Primary Responsibilities:
Ensure complaint has been categorized correctlyDetermine and confirm member eligibility and benefitsObtain additional documentation required for case reviewPlace relevant documents into image repositoryInitiate outbound contact to members or providersReview case to determine if review by Clinician is requiredResearch and resolve written complaints submitted by consumers and physicians/providersRender decision for non-clinical complaints using sound, fact-based decision makingDraft verbiage for use in outbound correspondencePrioritize and organize tasks to meet compliance deadlinesAbility to meet established productivity, schedule adherence, and quality standardsModerate work experience within own functionSome work is completed without established proceduresBasic tasks are completed without review by othersSupervision/guidance is required for higher level tasks

Requirements

Required Qualifications:
High School Diploma or GED1+ years of customer service experience analyzing and
solving customer problems, or 1+ years of experience in an office
setting environment using the telephone and computer as the primary
instruments to perform job dutiesExperience with Healthcare/ Medical/ Pharmacy terminologyProficiency in Microsoft Word (creating documents)Proficiency in Microsoft Excel (ability to make spreadsheets)Proficiency in Microsoft Outlook (ability to send and receive emails)Soft Skills:
Strong customer service orientationStrong communication/telephone skillsSound decision making skillsAbility to navigate multiple computer systemsCareers 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.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