UnitedHealth Group Jobs – Appeals Resolution Analyst

Website UnitedHealthcare

Job Description:

Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how UnitedHealth Group became a Fortune 10 company 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 10 company.

Job Responsibilities:

  • Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes
  • Render decision for non-clinical complaints using sound, fact-based decision making
  • Ensure complaint has been categorized correctly
  • Research and resolve written complaints submitted by consumers and physicians/providers
  • Review case to determine if review by clinician is required
  • Complete necessary documentation of final appeals or grievance determination using appropriate templates
  • Obtain additional documentation required for case review

Job Requirements:

  • High School Diploma / GED (or higher) or Equivalent work experience
  • Health Care/Insurance environment (familiarity with medical terminology, health plan documents, or benefit plan design)
  • Sales or account management experience
  • Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)
  • Minimum of 2+ years of combined education, work and/or volunteer experience
  • Assist customers in navigating myuhc.com and other UnitedHealth Group websites while encouraging and guiding them towards becoming self-sufficient in using these tools
  • Customer Service experience
  • Bilingual fluency in English and Spanishment scheduling or connections with internal specialists for assistance

Job Details:

Company:  UnitedHealthcare

Vacancy Type:  Full Time

Job Location: San Antonio, TX, US

Application Deadline: N/A

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