Appeals Representative - Norristown, PA

UHG Norristown, PA

About the Job

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.

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

Requirements:
  • High school diploma / GED or higher 
  • 1+ years of experience analyzing and solving customer problems OR 1+ 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
  • 1+ years of healthcare billing experience
  • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
Preferred Qualifications
  • Work experience using MS Excel (filtering, sorting, editing data on spreadsheets)
  • Experience with health care, medical, or pharmacy terminology
  • Experience working with the appeals process

OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

 

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance.  Join us and start doing 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:  Healthcare, health care, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing