Energize your career with one of Healthcare’s fastest growing companies.
You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
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 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.
- 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
- High School Diploma / GED (or higher)
- 1+ years 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
- 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 Microsoft Excel (filtering, sorting, editing data on spreadsheets
- Experience with health care, medical, or pharmacy terminology
- Experience working with the appeals process
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