18 days old

Clinical Appeals Representative - Cypress, CA

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 doing your life's best work.
For those who want to invent the future of Healthcare, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.
Positions in this function are responsible for setting up the Appeals and Grievance cases for the Coordinators, Nurses and Doctors to review for a determination of denial. Position consists of reading and analyzing the member's correspondence and determining what the complaint is which could lead to several different issues. The Clinical Appeals Representative needs to be able to distinguish between Quality of Care, Appeal, Grievances, Expedited, Claims, Referral issues and determining exactly what the member is wanting in their letters. Position involves, calling to obtain the correct information from Member, Medical Groups, Providers and other Departments. Position requires regulatory turnaround times. Accuracy is a very important part of this position.

Primary Responsibilities:

  • Receive appeal or grievance documentation and determine relevant details (e.g., what member is requesting)
  • Make outbound calls to members and / or providers to clarify appeal or grievance information
  • Determine where appeal or grievance should be reviewed / handled or route to other departments as appropriate
  • Contact and work with other internal resources to obtain and clarify information
  • Complete appeal or grievance review procedures according to relevant regulatory or contractual requirements, processes and timeframes

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: 2020-03-11 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.

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    Clinical Appeals Representative - Cypress, CA

    UnitedHealth Group
    Cypress, CA 90630

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