Position Description: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.(sm) Positions in this function are responsible for analyzing HMO claims disputes and / or network management cases.Primary Responsibilities:Determine if the dispute warrants additional payment, was overpaid or if the case was handled correctly the first time.Provide expertise in reviewing, researching, investigating and resolving all provider disputes, including complex issues.Validate information, review history on the case, and interpret the contract benefits. Communicate with appropriate internal business partners and providers regarding dispute issues, implications and decisions. Make outbound calls to providers as necessary to clarify, request additional information or discuss resolution of case.Research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.Analyzes and identify trends for provider issues.Completes special projects, as assigned, on a timely basis.Exhibits regular and predictable attendance and punctuality.Adhere to standards of professional conduct and dress codeDetail oriented, able to thoroughly document the issue and provide clear, concise written communication regarding the outcome.
Required Qualifications:High school diploma / GED or higher 3+ years experience in Medical Claims environment 3+ years experience interpreting provider contracts and benefits Experience with Employer & Individual and Medicare & Retirement lines of businessExperience with MS Office - Word (creating documents / templates / lists), Excel (data entry, sorting / filtering), & Outlook (send / receive email, create tasks, update calendar, set out of office)Preferred Qualifications:Understanding of Risk and a delegated modelNICE experience Physical Requirements and Work Environment: Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouseCareers 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: UnitedHealthcare, healthcare, medical claims, claims, provider, NICE, quality
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.