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.
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.
- Review patient files and utilize knowledge and skills as well as knowledge of payer requirements to determine if medical or dental claim is adjudicated correctly
- Proficiently read and understand information from patient medical records, claims history and DOL/State regulations
- Re-Price medical claims using PPO Network’s on-line systems/tools
- Utilize criteria and other resources and clinical evidence to develop sound and well-supported documentation for review decisions
- Coordinate drafting and mailing of letters related to member appeals
- Prepare feedback and participate in meetings
- Obtaining information by telephone as well as by hard copy and entering into the computer systems
- Prioritization of individual work flow associated with the case assignments
- Establishing and maintaining professional rapport with clients and providers (physicians and hospitals)
- Maintaining and assuring accuracy of documentation
- Meet and/or discuss with members, clients and providers the issues relating to claim administration
- Ability to report to the office
- Processing of medical and dental claims as needed
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.
- High School Diploma / GED (or higher)
- Experience working with Microsoft Word (ability to create, edit and save documents), Microsoft Excel (ability to create, edit and save spreadsheets) and Microsoft Outlook (ability to create, edit and save correspondences)
- 1+ years experience interpreting benefits
- 1+ years experience in processing medical, dental and/or vision claims
- Ability to work Monday - Friday, flexible hours from 7am - 6pm EST
- Effective organizational and prioritization skillsExcellent oral and written communication skills
- Ability to work in a fast paced multi-tasking environment
- Strong interpersonal skills with ability to function as a positive team member
- Strong mathematical background
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: UnitedHealth, UHG, Columbus, OH, Appeals