Senior Appeals Representative - Oldsmar, FL

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.SM
 
The role of an M&R Senior Claims Appeals Representative is to serve as a trusted resource in providing problem resolution and support for our Medicare members regarding their complex 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 complex questions and concerns. As a Senior Coordinator, this role is focused on the processing of highly complex and unique cases with minimum assistance. A key requirement of this role is to deal with our members in a compassionate manner – always remembering that there is a real person on the other end of the phone who may not understand their insurance coverage, and is looking for your help and support in navigating the health care system.
 
Primary Responsibilities:

Independently reviews the members’ case file to determine if representative / appellant is authorized party and if complaint is valid. These may include: Medical benefits, eligibility, claim payment, deductible limits and co-payments, pharmacy benefits, eligibility and claims, and billing and enrollment inquires
Demonstrates proficiency in determining if case requires creation of multiple complaint records and reviews correspond to determine classification and sub-type
Prioritizes workflow on a consistent basis, applies key HIPAA and CMS guidelines in daily workflow, and meets turnaround times for assigned cases
Research and investigate complex issues through the use of multiple internal computer databases, external computer systems and supporting technology, such as scanning / imaging
Partners with all service delivery functions ( i.e. clinical, claims, billing and enrollment) to answer member questions / or works with others to resolve escalated issues
Develops and delivers timely and professional communication dealing with complex issues at each step of the process to advise members of the progress and status of their issue. (Quality standards means that all correspondence must be error free - no spelling, punctuation, grammatical or other errors.)
Maintains system documentation on the tracking and monitoring of all cases as well as the final disposition to ensure overall compliance with Medicare regulations
Meets established productivity and quality standards in addition to attendance requirements

Required Qualifications: 

High School Diploma / GED
Experience in working in a dynamic office setting using multiple computer systems as the primary instrument to perform job duties
Ability to work from Monday to Friday in any shift between 8am-6pm
Preferred Qualifications:

1+ years of customer service experience analyzing customer problems
Physical Requirements and Work Environment:

Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
Operations center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do your life’s best work.SM
　
Diversity creates a healthier atmosphere: 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