Grow your career with an industry leader! We have training classes starting soon. Apply now! Are you the person your friends and family go to when they need advice or a listening ear? In this fast growing healthcare industry, UnitedHealth Group is searching for those individuals who can serve as a trusted resource to our members. You can be a part of the brightest and best team that are leading the way in improving the health and quality of life for our rapidly expanding customer base. Compassion is at the center of your life's best work. (SM) As a Senior Claims Appeals Representative, your role is to provide support to our members by investigating and responding to appeals related to their medical claims. You will review the available information and connect with members or providers by email and phone as needed for missing details. You will be expected to develop and maintain positive member relationships via telephone and written communication.This position is full-time (40 hours/week) Sunday - Saturday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (6am -8pm). It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 601 Brooker Creek Blvd, Oldsmar, FL 34677.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/uhgbenefits Primary Responsibilities:Handle escalated claims, drawing on experience and knowledge to resolve more complex customer issuesConducts research utilizing multiple internal computer databases and external systems on each case file to determine if the member making the appeal (or representative) is authorized and that the complaint is valid including situations such as benefits eligibility, claim payments, deductible limits and copayments, prescription benefits eligibility, and billing or enrollment inquiriesDetermines whether a case requires multiple complaint records; assigns classifications to each recordOutbound calls to Providers and Members to resolve missing or discrepant informationDelivers timely and professional communication via telephone or email to members with complex issues for each step of the process, notifying the member the progress and status of their issue; meet expected turnaround times for each assigned casePartner with other departments (i.e. clinical, claims, billing, etc.) to gather additional information in order to answer member questions or to resolve escalated issuesInput and maintain documentation to track and monitor progress of all cases as well as the final result to ensure overall compliance; apply key HIPPA guidelines in daily activities
A minimum education level of a high school diploma/GED; OR at ten years of equivalent working experienceDemonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs Demonstrated proficiency in using Microsoft Office (Outlook, Word & Excel) to complete work assignmentsAbility to compose written correspondence free of grammatical errors while also translating medical and insurance expressions into simple terms that members can easily understandConsistent attendance with ability to meet work schedule including the required training periodAbility to skillfully listen, gather the necessary information, determine next steps or resolution while meeting urgent regulatory timelines and remaining calm regardless of the members disposition or complexity of the issueSuccessful completion of the UnitedHealth Group new hire training and demonstrated proficiency requiredPreferred Qualifications:1 year of experience processing healthcare claims Experience analyzing and solving appeals and/or grievances preferredDemonstrated understanding of key HIPPA requirements and regulatory guidelinesThere 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/OurApplicationProcessCareers 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.
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.