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About UHG

Careers at UnitedHealth Group

 

We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Claims

Country:

United States

Postal Code:

43085

Approximate Salary:

Not Specified

Position Type:

Full Time

Senior Appeals Representative - Dublin, OH

UHG - Columbus, Ohio

Posted: 08/9/2018

Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how United Health Group became a Fortune 6 leader in healthcare. We did it by working to become an undisputed leader in creating service quality 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 great training, support and opportunities.


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 (6:00am-5:30pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 5900 Parkwood Place, Dublin, OH 43016.


There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application.  Once you submit your completed application, you will receive an e-mail with information regarding next steps including any pre-employment assessment(s) that are required.  Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: http://uhg.hr/OurApplicationProcess


Primary Responsibilities

  • 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 act as a subject matter expert for your team on applicable regulatory guidelines and privacy policies. You’ll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member. 


Required Qualifications

  • 2+ years of experience analyzing and solving appeals and grievances in an office environment using the telephone and computer as the primary instruments to perform job duties OR 2+ years of experience in a healthcare setting with knowledge of the medical claims and/or billing process
  • High school diploma or GED OR equivalent work experience
  • 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
  • Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product


UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life’s best work.SM



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, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing


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