C&S Senior Appeals Representative - Honolulu, HI
UnitedHealth Group - Honolulu, HI

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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 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.

Primary Responsibilities:
  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances.
  • Analyze and identify trends and provides reports as necessary
  • Consistently meet established productivity, schedule adherence, and quality standards
  • Provide excellent customer service
  • Extensive work experience within own function.
  • Work is frequently completed without established procedures.
  • Works independently.
  • May act as a resource for others.
  • May coordinate other's activities.

Requirements:
  • High school diploma/GED required
  • 1+ year medical claims processing knowledge and an understanding of medical terminology
  • Basic familiarity with Microsoft Word and Excel is required
  • Must have the ability to work overtime as business needs require
Assets:
  • Previous appeals/grievances experience is preferred
  • Proficient with COSMOS platforms; i.e. appeals and grievances lookup and validation
  • 2+ years of claims processing or adjustment experience preferred
  • Medicaid/Medicare Appeals and Grievances experience is preferred

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

UnitedHealth Group - 15 months ago - save job - block
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When you work to better people’s lives, one of those lives will always be yours. We have modest goals: Improve the lives of...