C & S Appeals Representative - Phoenix, AZ - 729920
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
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.
Responsible for providing expertise or general support to teams in reviewing, researching, investigating all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues. Analyzes and identifies trends for all appeals and grievances. May research written Department of Insurance complaints and complex or multi - issue provider complaints submitted by consumers and physicians / providers.
Enter provider or member submission into appeal data base
Ensure submission has been categorized correctly
Determine and confirm member eligibility and benefits
Place relevant documents into image repository
Initiate outbound contact to members or providers
Review case to determine if review by Clinician is required
Draft verbiage for use in outbound correspondence
Prioritize and organize tasks to meet compliance deadlines
Ability to meet established productivity, schedule adherence, and quality standards
Moderate work experience within own function
Work less complex special projects
Basic tasks are completed without review by others
Supervision / guidance is required for higher level tasks
Ensure all incoming receipts are processed within required time frames to meet performance guarantees
Participate in meetings to share, discuss, and solution for question or error trends, as well as potential process improvements
Identify issue trends affecting multiple areas and escalate to appropriate partners
Participate in individual coaching sessions as requested by management
Attend group training sessions as requested by management
To be considered for this position, applicants need to meet the qualifications listed in this posting.
High School Diploma / GED or higher
Must be able to work overtime and weekend hours as business needs dictate
6 months of experience working with a computer and windows PC applications with the ability to learn new computer systems quickly
1 years claims processing experience or experience in analyzing and solving appeals & grievances
Knowledge in utilizing Cosmos and / or Facets (RV, Unison or CSP) claim platforms
Experience with healthcare / medical terminology
Ability to complete acknowledgement letter writing utilizing appropriate grammar
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Take the next step, online at: www.yourlifesbestwork.com
Careers 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.
is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: data entry, scanning, appeals, support, grievances,
Job Reference #:
Website : http://www.unitedhealthgroup.com/
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term