You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to 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 appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyzes and identifies trends for all appeals and grievances. May research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians / providers. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.
Manages and is accountable for professional employees and / or supervisors. Impact of work is most often at the local level.
Knowledge of CMS regulatory guidelines (i.e. Chapters 13 and 18). Works with Compliance / Regulatory Affairs and Legal teams that support the Government business units for interpretation of guidelines to resolve member appeal issues
Strong understanding of benefit operations functional areas that have an upstream / downstream impact
Develop working relationships with internal business partners for problem resolution purposes
Works closely with Legal, Compliance and Regulatory Affairs
Identify process gaps and lead process improvement activities
Proactively manage inventory, overtime, and throughput
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.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.