12 days old

Appeals Representative - Cypress, CA - 928547

Cypress, CA 90630
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  • Job Code
    928547

This role is temporarily remote. Training is conducted virtual 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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Lets talk about diplomacy. Lets talk about accuracy. Lets talk about how UnitedHealth Group became a Fortune 10 company 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, heres 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. Youll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, well provide you with the great training, support and opportunities youd expect from a Fortune 10 company.

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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 (8:00am - 5:00pm). It may be necessary, given the business need, to work occasional overtime.

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We offer 8 weeks of paid training. The hours during training will be 8:00am to 4:30pm Monday-Friday.Training will be conducted virtually from your home.

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Our office is located at 5757 Plaza Drive, Technology Center, Cypress, California 90630.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Primary Responsibilities:

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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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  • 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 written complaints submitted by consumers and physicians / providers
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  • Render decision for non - clinical complaints using sound, fact - based decision making
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  • Draft verbiage for use in outbound correspondence
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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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  • Moderate work experience within own function
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  • Some work is 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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  • If you need to enter a work site for any reason, you will berequiredto 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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This is a challenging role with serious impact. Youll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. Youll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member.

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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) OR equivalent years of work experience
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  • 1+ years of experience analyzing and solving customer problems OR 1+ years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
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  • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
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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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  • 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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Preferred Qualifications:

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  • Experience with health care, medical, or pharmacy terminology
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Soft Skills:

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  • Strong written communication skills including advanced skills in grammar and spelling
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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. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status. 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.

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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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Taking care of business at UnitedHealth Group translates to more meaning and impact as you help improve the lives of millions. Join us. Learn more about how you can start doing your lifes best work.SM
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"Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 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

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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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Keywords: Healthcare, health care, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing. #rpo,work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately

Posted: 2021-06-11 Expires: 2021-07-11

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 - 928547

UnitedHealth Group
Cypress, CA 90630

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