Appeals & Grievance Representative - Indianapolis, IN, Lawrenceville, IL, Green Bay, WI (884355)
About the Job
Position Description Senior Appeals Representative – Indianapolis, IN; Lawrenceville, IL; Green Bay, WILet’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how UnitedHealth Group became a Fortune 6 leader in healthcare. We did it by working to become an undisputed leader in creating service quality 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 great training, support and opportunities. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of 7am – 6pm EST. It may be necessary, given the business need, to work occasional overtime. 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 makingComplete necessary documentation of final appeals or grievance determination using appropriate templatesCommunicate appeal or grievance information to members or providers and internal/external parties within the required timeframes 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 act as a subject matter expert for your team on applicable regulatory guidelines and privacy policies. You’ll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.