Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how United Health Group became a Fortune 6 leader in health care. We did it by working to become an undisputed leader in creating quality service and helping to improve the lives of millions. Now, here’s where you come in. You can build on your problem solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You’ll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we’ll provide you with the great training, support and opportunities you’d expect from a Fortune 6 leader.
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 (8:00am-6:00pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 5900 Parkwood Place, Dublin, OH 43016.
- Research and resolve written complaints submitted by consumers and physicians/providers
- Ensure complaint has been categorized correctly
- Obtain additional documentation required for case review
- Review case to determine if review by clinician is required
- Render decision for non-clinical complaints using sound, fact-based decision making
- Complete necessary documentation of final appeals or grievance determination using appropriate templates
- Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes
This is a challenging role with serious impact. You’ll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. You’ll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member.
- High school diploma or GED OR equivalent years of work experience
- 1+ year of experience analyzing and solving customer problems OR 1+ year of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
- Strong written communication skills including advanced skills in grammar and spelling
- Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
- Experience with health care, medical, or pharmacy terminology
Careers 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.
Key words: Healthcare, health care, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing