Senior Appeals Representative - Phoenix, AZ

Company:	UnitedHealth Group Company Profile \| Current Opportunities (64)
Job Location(s):	Phoenix
Employment Term:	Regular
Employment Type	Full Time
Start Date:	As soon as possible
Starting Salary Range:	Not Provided
Required Experience:	Open
Related Categories:	Accounting - General, Consulting Services, Accounting - Bookkeeping/Clerical

Position Description

Senior Appeals Representative - Phoenix, AZ-333341

Description

Position Description:

Positions in this function are responsible for providing expertise in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. You will have the ability to work with multi-functional units to resolve issues and meet production metrics.

Primary Responsibilities:

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 appeals submitted by consumers and physicians/providers
Extensive work experience within own function
Work is frequently completed without established procedures
Works independently
May act as a resource for others
Process member and regulator appeals by investigating all relevant information and prepare written notification responses
Completion of member and provider appeal cases in specified time frame
Work with internal departments to resolve appeal cases
Act as liaison with regulatory agencies regarding member and provider appeals
Maintain accurate information in database

AmeriChoiceis part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Qualifications

Qualifications:

High School diploma or GED required
1 year of PC knowledge (Microsoft Word and Excel) is required
1 year of medical claims processing experience is required
3 years of experience in the Medical Industry is preferred
Knowledge of managed care products preferred
Ability to master GTS, Diamond and CAID claims processing systems
Must be willing to work regular / extended hours when necessary to meet deadlines

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Claims Appeals

Primary LocationUS-AZ-Phoenix

Organization AMC APIPA

Schedule Full-time

Number of Openings 2