UnitedHealth Group Appeals Representative - Green Bay, WI or Indianapolis, IN or Lawrenceville, IL in Indianapolis, Indiana

Let's talk about diplomacy. Let's talk about accuracy. Let's talk about how United Health Group became a Fortune 6 leader in health care. We did it by working to become an undisputed leader in creating quality service 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 the great training, support and opportunities you'd expect from a Fortune 6 leader.

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 also need to effectively draft correspondence that explains the claim resolution / outcome as well as next steps / actions for the member.

Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, and investigating 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.

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

  • Moderate work experience within own function

  • Some work is completed without established procedures

  • Basic tasks are completed without review by others

  • Supervision / guidance is required for higher level tasks

Requirements:

  • High School Diploma / GED or higher

  • 3+ years of experience analyzing and solving customer problems OR 2+ years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools

  • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

  • Ability to work overtime as needed

Preferred Requirements:

  • Managed Care and previous Appeals / Grievances experience

Soft Skills:

  • Strong written communication skills including advanced skills in grammar and spelling

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work. SM

Diversity 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: Appeals, Representative, Grievances, Appeals, Green Bay, WI