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Senior Appeals Representative

UnitedHealth GroupLetterkenny, Donegal

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.

When a medical insurance claim is denied it can be a time of great stress and anxiety for our members, we offer them the ability to appeal that decision, which is where your role as an appeals coordinator delivering world class customer service begins.

The successful candidate will be responsible for researching, investigating and resolving all types of appeals cases whilst delivering exceptional customer service to our members. The role involves communicating with appropriate parties regarding the issues raised, in order to clearly understand and resolve the reason for the appeal. As part of your duties you will be required, when appropriate, to contact the provider/member by telephone. As an Appeals coordinator you will be responsible for the entire lifecycle of an appeals case. From the initial review through to the final decision of the case you will retain ownership and oversight. Timeliness of case handling and its accuracy will be core responsibilities of the role.

Upon carrying out a full and comprehensive review of the case you will have established that the original decision made by the business was correct or not. As an appeals coordinator, you will be responsible for completing all operational processes to resolve the appeal whilst focused on providing exceptional customer service, cumulating in a phone call to the member, advising them of your decision. A core competency of the role is adherence to the collation and recording of all the required materials that are used to determine the outcome of the case.

Main Responsibilities:

  • Analyze/research/understand how a claim was processed and why it is under dispute
  • Identify/obtain all necessary medical records for any appeal which requires a clinical review
  • Leverage appropriate resources to obtain all information relevant to the claim
  • Proactively identifies solutions to non-standard cases.
  • Solves moderately complex problems on own.
  • Ensures members receive exceptional customer service.
  • Plans, prioritizes, organizes and completes work to meet operational performance metrics.
  • Document and communicate final determination of appeals using appropriate templates, communication processes in a timely manner to all applicable parties
  • Understand and adhere to applicable federal/state laws and regulations
  • Maintain confidentiality of member appeals information per HIPPA regulations
  • Understand and adhere to applicable documentation handling policies and regulations

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.

Requirements

  • Diploma qualification and / or equivalent work experience in a customer service environment
  • Experience in handling customer calls or complaints
  • Excellent communications skills both written and verbally
  • Proven Computer literacy with office-based applications (e.g. Word, Excel, Powerpoint, Visio etc)
  • A proven critical thinker

Preferred

  • Experience in processing healthcare/insurance claims
  • Experience of the USA health system

This will be an office based position.

The successful candidates will be taken through a comprehensive 6 week training course during which the expectation is that PTO will not be available for the duration.

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do 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.

Keywords: Senior Appeals Representative, Letterkenny, Ireland, IR, RPO

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