4 days old

Appeals Representative - New Hyde Park, NY

New Hyde Park, NY 11040
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  • Job Code
    861758

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.SM


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 also need to effectively draft correspondence that explains the claim resolution / outcome as well as next steps / actions for the member.


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 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.
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Posted: 2020-05-20 Expires: 2020-06-19

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 - New Hyde Park, NY

UnitedHealth Group
New Hyde Park, NY 11040

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