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Appeals Representative (Dental)

UnitedHealth Group

UnitedHealth Group

Appeals Representative (Dental)

Cypress, CA
Full Time
Paid
  • Responsibilities

    POSITION DESCRIPTION

    Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing YOUR LIFE'S BEST WORK.SM Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of Dental appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyzes and identifies trends for all appeals and grievances. Will research and resolve written Regulatory complaints and complex or multi - issue provider complaints submitted by consumers and dental providers

    PRIMARY RESPONSIBILITIES:

    • Work Independently
    • Some work may need to be completed without established procedures
    • Basic tasks are completed without review by others
    • Supervision/guidance is required for higher level tasks
    • Utilizing Omega and Webstation
    • Ensure complaint has been categorized correctly
    • Determine and confirm member eligibility and benefits
    • Obtain additional documentation required for case review
    • Log and route appeals
    • Place relevant documents into image repository
    • Initiate outbound contact to members or providers
    • Review case to determine if review by Clinician is required
    • Research and resolve verbal and written complaints submitted by consumers and providers
    • Render decision for non - clinical complaints using sound, fact - based decision making
    • Utilize applicable tools/resources to investigate and document
    • Prioritize and organize tasks to meet compliance deadlines
    • Ability to meet established productivity, schedule adherence, and quality standards
    • Complete necessary documentation of final appeals or grievance determination using appropriate templates
    • Draft verbiage for use in outbound correspondence
    • Communicate appeal or grievance information to members or providers and internal/external parties within the required time frames

    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.

  • Qualifications

    REQUIRED QUALIFICATIONS:

    • High School Diploma / GED (or higher)
    • 2+ years of experience analyzing and solving appeals and grievances in an office environment using the telephone and computer as the primary instruments to perform job duties
    • Ability to create, copy, edit, send, and save in Microsoft Office applications including Microsoft Word, Microsoft Excel, and Microsoft Outlook
    • Previous experience with creating resolution letters
    • Ability to work Monday to Friday, 8AM to 5PM and mandatory overtime between 1 to 20 hours per week as needed

    Preferred Qualifications:

    • Experience utilizing, ETS, FACETS, and ISET
    • Experience in a healthcare setting with knowledge of the dental claims and/or billing process
    • Experience working in a Dental office setting using the telephone and computer as the primary instruments to perform job duties
    • Experience with Dental and Vision terminology

    SOFT SKILLS:

    • Ability to ask probing questions to identify underlying issues
    • Ability to think analytically
    • Issue resolution skills as well as the ability to interact with internal and external customers and business partners verbally and in writing

    CAREERS AT UNITEDHEALTHCARE EMPLOYER & INDIVIDUAL. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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. Candidates are required to pass a drug test before beginning employment.

  • Industry
    Hospital and Health Care
  • Fun Fact
    UnitedHealth Group is working to create the health care system of tomorrow.
  • About Us

    A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.