14 days old

Senior Appeals Representative - Tethered - Seattle, WA

Seattle, WA 98104
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  • Job Code
    866941

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.


Let's talk about diplomacy. Let's talk about accuracy. Let's talk about how United Health Group became a Fortune 6 leader in healthcare. We did it by working to become an undisputed leader in creating service quality and helping to improve the lives of millions. Now, here's 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. You'll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we'll provide you with great training, support and opportunities.

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 act as a subject matter expert for your team on applicable regulatory guidelines and privacy policies. 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 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.

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Posted: 2020-03-14 Expires: 2020-04-13

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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Senior Appeals Representative - Tethered - Seattle, WA

UnitedHealth Group
Seattle, WA 98104

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