Appeals Representative - Remote in California

Company: UnitedHealth Group
Location: San Jose
Posted on: September 22, 2022

Job Description:

If you are located within the state of California, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. - 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 This position is full - time, Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM -including the flexibility to work occasional overtime and weekends based on business need. We offer 4 - 6 weeks of training. -Training will be conducted virtually from your home. *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary Responsibilities: -

• Ensure complaint has been categorized correctly -
• 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 physicians / 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 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 customer service experience with analyzing and solving customer problems OR 1+ years of experience in an office setting environment, using the telephone and computer as the primary instruments to perform job duties -
  • Experience with using Microsoft Office: Microsoft Word (create, copy, edit, send, and save documents), Microsoft Excel (create, copy, edit, send, and save spreadsheets), and Microsoft Outlook (create, copy, edit, send, and save emails) -
  • Ability to work any 8-hour shift between the hours of 8:00 AM - 5:00 PM from Monday - Friday including the flexibility to work occasional overtime and weekends based on business need Preferred Qualifications:
    • Previous experience with utilizing ETS, FACETS, VAS, and ISET--- -
    • Experience with Dental and Vision terminology on appeals and / OR claims Telecommuting Requirements:
      • Reside within the state of California
      • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
      • Ability to keep all company sensitive documents secure (if applicable)
      • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Soft Skills: -
        • Ability to navigate multiple computer systems - UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status. Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Learn how Teresa, a Senior Quality Analyst, -works with -military veterans and ensures they receive the best benefits and experience possible. - 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: #RPO, #YELLOW

Keywords: UnitedHealth Group, San Jose , Appeals Representative - Remote in California, Other , San Jose, California