16 days old

Appeals & Grievances Representative - San Juan, PR - $500 Sign-on bonus for external candidates - 944496

Blanding, UT 84511
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  • Job Code
    944496

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

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Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. This position will communicate with appropriate parties regarding appeals and grievance issues, implications and decisions. In addition, analyze and identifies trends for all appeals and grievances.

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Primary Responsibilities:

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  • Demonstrate awareness of the impact of claims business processes/changes on other parts of the business
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  • Applies knowledge/skills to a range of moderately complex activities
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  • Demonstrates great depth of knowledge/skills in own function
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  • Proactively identifies solutions to non-standard requests
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  • Solves moderately complex problems on own
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  • Works with team to solve complex problems
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  • Plans, prioritizes, organizes and completes work to meet established objectives
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  • Position will required to do outbound calls to providers
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  • May coordinate work of other team members
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*** ENGLISH PROFICIENT ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***

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Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

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Required Qualifications:

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  • High school diploma
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  • 1+ year of experience in a production environment
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  • Experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
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  • Experience with Microsoft Tools: Microsoft Word (creating memos, writing), Microsoft Outlook (setting calendar appointments, email) and Microsoft Excel (creating spreadsheets, filtering, navigating reports)
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  • Ability to work 40 hours / week during standard business operating hours Monday - Friday from 6am - 6pm AST
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  • Bilingual proficiency in English & Spanish (verbal and written)
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  • You will be asked to perform this role in an office setting or other company location.
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
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Preferred Qualifications:

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  • Associate degree or higher
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  • Claims Experience
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  • Experience with healthcare/medical terminology strongly
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  • Working knowledge of Medicaid claims filing experience.
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  • Working knowledge of Cosmos/CSP Facets platforms
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Appeals Representative, Appeals Analyst, Representative, San Juan, Puerto Rico, PR

Posted: 2021-07-10 Expires: 2021-08-09

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Sponsored by:
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Appeals & Grievances Representative - San Juan, PR - $500 Sign-on bonus for external candidates - 944496

UnitedHealth Group
Blanding, UT 84511

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