- Receive appeal or grievance documentation and determine relevant details (e.g., what member is requesting)
- Make outbound calls to members and / or providers to clarify appeal or grievance information
- Determine where appeal or grievance should be reviewed / handled or route to other departments as appropriate
- Contact and work with other internal resources to obtain and clarify information
- Complete appeal or grievance review procedures according to relevant regulatory or contractual requirements, processes and timeframes
- High School Diploma / GED or higher
- 6+ months of Telephonic Customer Service experience
- 35+ wpm typing skills
- Experience using a computer and Microsoft Office - Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort, filter, and work within tables), and Microsoft Outlook (email and calendar management)
- Bilingual fluency in English and Spanish
- Experience in Claims, Managed Care HMO, Doctor's office, and / or Billing
- Medical Terminology experience
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: UHG, California, customer service, healthcare, telephonic, patient interaction, field based, advocacy