Are you the person your friends and family go to whenthey need advice or a listening ear? In this fast growing health care industry,UnitedHealth Group is searching for those individuals who can serve as atrusted resource to our members. You can be a part of the brightest and bestteam that are leading the way in improving the health and quality of life forour rapidly expanding customer base. Compassion is at the center of yourlife's best work.As a Claims Complaint ResolutionRepresentative, your role is to provide issue resolution and compassionatesupport to our members and providers concerning their complex complaints theyhave directed to Medicare. In order to do so, you will be expected to developand maintain positive member relationships via telephone and writtencommunication, as well as exhibit strong and effective de-escalation skills andadvanced research abilities. You will also be documenting detailed notes aboutthe handling, research and outcome of your complaint case to be provided toCenters for Medicare & Medicaid Services for their review and feedback, asappropriate. This position is full-time (40 hours/week) Tuesday -Saturday. Employees are required to have flexibility to work any of our 8 hourshift schedules during our normal business hours (6am to 8pm). It may benecessary, given the business need, to work occasional overtime or holidays.Our office is located at 5900 Parkwood Place in Dublin, Ohio.What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings includes:18 days of Paid Time Off which you start to accrue with your first pay period plus 8 Paid HolidaysMedical Plan options along with participation in a Health Spending Account or a Health Saving accountDental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage401(k) Savings Plan, Employee Stock Purchase PlanEducation Reimbursement - up to $5,250 per calendar year for job-related courseworkAssistance PlanEmployee DiscountsEmployee Assistance ProgramEmployee Referral Bonus ProgramVoluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)More information can be downloaded at: http://uhg.hr/uhgbenefitsPrimary Responsibilities:Acknowledge receipt of complainant outreach throughcompany tracking softwareConduct non-biased, accurate, timely and comprehensiveinvestigation of all the facts related to the complaintCommunicate, collaborate and coordinate with businesspartners to review and analyze applicable regulatory standards as necessary forappropriate issue resolution, including escalation to business leaders whennecessaryResponsible for the gathering of all relevant informationfrom the member and / or provider regarding the complaint, determining theappropriate resolution of the complaint per standard policies and proceduresand ensuring that all internal processes are completed to resolve the issueThoroughly document all action taken on behalf of themember or provider to resolve the complaint, maintaining accuracy andtimeliness of updatesComplete verbal outreach to the complainants or composewritten correspondence to members to communicate resolution outcomes inaccordance to plan policy and guidelinesEnsure that all complaints are processed in adherence tothe Centers for Medicare and Medicaid guidelines and plan policyMaintain compliance delivery requirements and turnaroundtimes / service level agreements on multiple cases at different stages ofcompletion
Required Qualifications: An educationlevel of a high school diploma/GED; OR equivalent working experienceDemonstratedability in using computer and Windows PC applications, which includes strongkeyboard and navigation skills and learning new computer programs as well as proficiencyin using Microsoft Office (Outlook, Word & Excel) to complete workassignmentsDemonstratedunderstanding of key HIPPA requirements and regulatory guidelinesAbility tocompose written correspondence free of grammatical errors while alsotranslating medical and insurance expressions into simple terms that memberscan easily understandAbility toskillfully listen, gather the necessary information, determine next steps orresolution while meeting urgent regulatory timelines and remaining calmregardless of the members disposition or complexity of the issuePreferred Qualifications:At least one yearof experience in a customer service or office setting, using a telephone andcomputer to solve customer issuesThere are several steps in our hiring process - it's a thorough process because we want to ensure the best job and culture fit for you and for us. In today's ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you'll receive an email with next steps. This may include a link for an on-line pre-screening test that we ask you to complete as part of our selection process. You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail. http://uhg.hr/OurApplicationProcess Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SMDiversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Keywords: Insurance, customer service, customer service representative, claims, appeals, call center, phone support, dispute resolution, healthcare, UnitedHealthcare, UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.