UnitedHealth Group
Dental Appeals Representative - Cypress, CA
At a glance
Location: US-CA-Cypress Map
Posted: 10/17/2019
Closing: 11/16/2019
Degree: Not Specified
Type: Full-Time
Experience: Not Specified
UnitedHealth Group
Job 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 reviewing, researching, investigating, and triaging all types of appeals and grievances and communicating with appropriate parties regarding appeals and grievance issues.


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 dental providers


Primary Responsibilities:

  • Ensure complaint has been categorized correctly
  • Utilizing Omega and Webstation 
  • Determine and confirm member eligibility and benefits
  • Obtain additional documentation required for case review
  • Place relevant documents into image repository
  • Initiate outbound contact to members or providers
  • Review case to determine if review by Clinician is required
  • Research and resolve written complaints submitted by consumers and providers
  • Render decision for non - clinical complaints using sound, fact - based decision making
  • Draft verbiage for use in outbound correspondence
  • Prioritize and organize tasks to meet compliance deadlines
  • Ability to meet established productivity, schedule adherence, and quality standards
  • 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
  • Work Independently


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.


Required Qualifications:

  • High School Diploma / GED (or higher)
  • 1+ years of experience working in a Dental office setting environment using the telephone and computer as the primary instruments to perform job duties)
  • Ability to create, copy, edit, send, and save in Microsoft Office applications including Microsoft Word, Microsoft Excel, and Microsoft Outlook
  • Ability to work Mandatory overtime between 1 to 20 hours per week as needed

Preferred Qualifications:

  • Experience utilizing, ETS, FACETS, and ISET
  • Experience with Dental and Vision terminology on appeals and / or claims

Soft Skills:

  • Must have letter writing skills


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 healthcare. 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: UHG, Cypress, CA, Dental, office, data entry, customer service

Dental Appeals Representative - Cypress, CA