1+ months

Appeals Representative - Cypress, CA - 922145

Cypress, CA 90630
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  • Job Code
    922145

This role is temporarily remote. Training is conducted virtually from your home. This role is an onsite role and you will transition once training is completed to work in the office in the future.

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When offices reopen, this role will start at the location at 5757 Plaza Dr. Technology Center,Cypress, CA 90630 and will eventually move to the office at 5701 Katella Avenue,Cypress, CA 90630.

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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 doingyour 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 Dental appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyzes and identifies trends for all appeals and grievances. Will research and resolve written Regulatory complaints and complex or multi - issue provider complaints submitted by consumers and dental providers

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Primary Responsibilities:

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  • Work Independently
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  • Some work may need to be completed without established procedures
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  • Basic tasks are completed without review by others
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  • Supervision/guidance is required for higher level tasks
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  • Utilizing Omega and Webstation
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  • Ensure complaint has been categorized correctly
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  • Determine and confirm member eligibility and benefits
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  • Obtain additional documentation required for case review
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  • Log and route appeals
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  • Place relevant documents into image repository
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  • Initiate outbound contact to members or providers
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  • Review case to determine if review by Clinician is required
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  • Research and resolve verbal and written complaints submitted by consumers and providers
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  • Render decision for non - clinical complaints using sound, fact - based decision making
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  • Utilize applicable tools/resources to investigate and document
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  • Prioritize and organize tasks to meet compliance deadlines
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  • Ability to meet established productivity, schedule adherence, and quality standards
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  • Complete necessary documentation of final appeals or grievance determination using appropriate templates
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  • Draft verbiage for use in outbound correspondence
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  • Communicate appeal or grievance information to members or providers and internal/external parties within the required time frames
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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 / GED (or higher)
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  • 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
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  • Proficiency with computer and Windows PC applications, including Microsoft Office - Microsoft Word (creating, editing, saving and sharing documents), Microsoft Excel (creating, saving, editing, sharing files, using formulas) and Microsoft Outlook (creating rules and using calendar, create, copy, edit, save and send correspondence)) and the ability to navigate and learn new and complex computer system applications
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  • Ability to work Mandatory overtime between 1 to 20 hours per week as needed
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  • Previous experience with creating resolution letters
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  • You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Telecommuting Requirements:

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  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
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  • Ability to keep all company sensitive documents secure
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  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
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Preferred Qualifications:

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  • Experience utilizing, ETS, FACETS, and ISET
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  • Experience in a healthcare setting with knowledge of the dental claims and/or billing process
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  • Experience working in a Dental office setting using the telephone and computer as the primary instruments to perform job duties
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  • Experience with Dental and Vision terminology
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Soft Skills:

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  • Ability to ask probing questions to identify underlying issues
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  • Ability to think analytically
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  • Issue resolution skills as well as the ability to interact with internal and external customers and business partners verbally and in writing
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UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

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Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your lifes 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 Groupis a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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Keywords: appeals, grievances, dental, hiring immediately, Cypress, California, claims, billing, Omega, Webstation, correspondence, Regulatory, FACETS, ETS, ISET, healthcare, UHG, Unitedhealthcare, hiring immediately, #rpo

Posted: 2021-05-06 Expires: 2021-07-04

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.

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Appeals Representative - Cypress, CA - 922145

UnitedHealth Group
Cypress, CA 90630

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