Energize your career with one of Healthcare’s
fastest growing companies.
You dream of a great career with a great
company – where you can make an impact and help people. We dream of giving you the opportunity to do
just this. And with the incredible
growth of our business, it’s a dream that definitely can come true. Already one
of the world’s leading Healthcare companies, UnitedHealth Group is restlessly
pursuing new ways to operate our service centers, improve our service levels
and help people lead healthier lives. We
live for the opportunity to make a difference and right now, we are living it
This opportunity is with one of our most
exciting business areas: Optum – a growing part of our family of companies that
make UnitedHealth Group a
Fortune 6 leader.
Optum helps nearly 60
million Americans live their lives to the fullest by educating them about their
symptoms, conditions and treatments; helping them to navigate the system, finance
their healthcare needs and stay on track with their health goals. No other
business touches so many lives in such a positive way. And we do it all with
every action focused on our shared values of Integrity, Compassion,
Relationships, Innovation & Performance.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms,
conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity,
Compassion, Relationships, Innovation and Performance.
Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties’ issues, implications and decisions. Analyzes and identifies trends for appeals and grievances. This includes senior level positions with education / certification / licensure other than an RN, such as BSW, MSW, DDS, Chiropractor, Physical
Therapist, etc. (Positions responsible for claims appeals can be found in the Claims job family.)
Provide Phone Support to drive resolution of caller Questions / IssuesDevelop and Maintain Productive Relationships / Interactions with CallersFamiliar with Business / Industry concepts and terminology as pertains to appeals and grievancesProvide Consulting / Education on Caller Issues / Trends as pertains to Appeals and grievancesResolve member service inquiries related to member and provider appeals and grievancesProcess telephone inquiries regarding: Basic appeal rights, Appeals status, General process, Basic complaints, Urgent appealsTriage calls to determine call type and transfer to the appropriate department as necessaryRefax letters to providers and facilities, as necessaryEnsure accurate documentation of callsIdentify requests for escalation / complaints and escalate accordinglyRoute identified issues to the appropriate site, as necessaryManage calls efficiently and effectivelyOwn problem through to resolution on behalf of the member / provider / facility in real time or through comprehensive and timely follow - up with the member /provider / facilityResearch complex issues across multiple databases and work with support resources to resolve inquiryParticipate in special projects, work groups or committees as assignedOther duties as assigned
High School Diploma / GED or higher1+ years of Call Center Customer Service experience 1+ years of Healthcare Insurance experienceExperience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)Ability to navigate a PC to open applications, send emails and conduct data entryAbility to work Monday through Friday between hours of 7:00 am - 7:00 pm
Familiarity with Medical TerminologyExperience with ClaimsAny college experience
Here's the idea. We built an entire organization around one giant objective;
make the health system work better for everyone. So when it comes to how we use
the world's large accumulation of health - related information, or guide health
and lifestyle choices or manage pharmacy benefits for millions, our first goal
is to leap beyond the status quo and uncover new ways to serve. Optum, part of
the UnitedHealth Group family of businesses, brings together some of the
greatest minds and most advanced ideas on where health care has to go in order
to reach its fullest potential. For you, that means working on high performance
teams against sophisticated challenges that matter. Optum, incredible ideas in
one incredible company and a singular opportunity to do your life's best
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.
UnitedHealth Group is a drug - free workplace.
Candidates are required to pass a drug test before beginning employment.
Keywords: Customer Service, Call Center, Healthcare, Appeals, research, Claims, Optum, UnitedHealthcare, Atlanta,GA