5 days old

Appeals Representative (Dental) - Cypress, CA

Cypress, CA 90630
Apply Now
Apply on the Company Site
  • Job Code
    866720

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

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

Primary Responsibilities:

  • Work Independently
  • Some work may need to be completed without established procedures
  • Basic tasks are completed without review by others
  • Supervision/guidance is required for higher level tasks
  • Utilizing Omega and Webstation
  • Ensure complaint has been categorized correctly
  • Determine and confirm member eligibility and benefits
  • Obtain additional documentation required for case review
  • Log and route appeals
  • Place relevant documents into image repository
  • Initiate outbound contact to members or providers
  • Review case to determine if review by Clinician is required
  • Research and resolve verbal and written complaints submitted by consumers and providers
  • Render decision for non - clinical complaints using sound, fact - based decision making
  • Utilize applicable tools/resources to investigate and document
  • Prioritize and organize tasks to meet compliance deadlines
  • Ability to meet established productivity, schedule adherence, and quality standards
  • Complete necessary documentation of final appeals or grievance determination using appropriate templates
  • Draft verbiage for use in outbound correspondence
  • Communicate appeal or grievance information to members or providers and internal/external parties within the required time frames
You'll 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.",
Posted: 2020-03-25 Expires: 2020-04-25

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.

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Appeals Representative (Dental) - Cypress, CA

UnitedHealth Group
Cypress, CA 90630

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast