Appeals Representative - Kingston, NY

Primary Responsibilities:

Demonstrate exceptional service in every internal and external interaction by anticipating customer requirements and meeting or exceeding them consistently
Assess issues where stakeholders are reporting claims payment problems, including claims and data analysis
Determine where in the health plan or Physical Health processes the issue may have occurred and what the root cause is
Create and execute action plan to achieve resolution including partnering with internal and external stakeholders to address process gaps, process failures and human error
Communicate status of issue resolution to internal and external stakeholders
Document case actions in RICHE/ARCHE
Complete notices to members and providers as required by law and within required timeframes if the case was received as a formal complaint or appeal
Act as a mentor for Level 1 Service Coordinators, advising on how to handle more complex cases
Continuous improvement of customer service skills
Other duties including data entry, typing, photocopying, and filing as needed to support job responsibilities
Ability to work well across different sections of the company

 Requirements Requirements:

An education level of at least a high school diploma or GED required
2+ years of experience analyzing and solving customer problems in an office setting environment using the telephone and computer as the primary instruments to perform job duties is required
Moderate Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications is required
MS Word and Excel is required
Authorization to work in the United States
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Previous claims/appeals knowledge is helpful
Working in the medical healthcare industry is preferred
Must have excellent written and verbal communication skills

Physical Requirements and Work Environment:

Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
Office environment

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

OptumHealth 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 health care 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.

At OptumHealth, you will perform within an innovative culture thats focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact thats greater than youve ever imagined.

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.

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Country: USA, State: New York, City: Kingston, Company: UnitedHealth Group.