Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how United Health Group / Optum became a Fortune 6 leader in healthcare. 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.Research and resolve written complaints submitted by consumers and Physicians / ProvidersEnsure complaint has been categorized correctlyObtain additional documentation required for case reviewReview case to determine if review by clinician is requiredRender decision for non - clinical complaints using sound, fact - based decision makingComplete necessary documentation of final appeals or grievance determination using appropriate templatesCommunicate 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 / GED or higher
- 1+ years of experience analyzing and solving customer problems OR 1+ years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
- 1+ years of healthcare billing experience
- Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
- Work experience using MS Excel (filtering, sorting, editing data on spreadsheets)
- Experience with health care, medical, or pharmacy terminology
- Experience working with the appeals process
Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to 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: Healthcare, health care, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing