Senior Appeals Representative - Fort Worth, TX OR Remote

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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

This position provides prompt, accurate and courteous communications to insureds, agents, healthcare providers, Department of Insurance representatives and attorneys. This position reviews, analyzes and responds to appeals and information requests within established Company and State guidelines.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 300 Burnett St Fort Worth, TX 76102.

Primary Responsibilities:
  • Resolves customer concerns and reports events and conclusions in an appropriate manner
  • Interprets State rules and regulations for applicability to Company business
  • Interprets all products administered by the Company and adheres to all State Insurance Department regulations regarding claims and appeal handling
  • Additionally, this position handles the subrogation files associated with third party liability claims
  • Acts as litigation liaison to the legal department
  • Assists with Compliance reporting and regulatory issues, liaison for market conduct exams to the legal department
  • Assists with large case management, assists with agent compliance and/or training.

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.

Required Qualifications:
  • High school diploma / GED (or higher) OR equivalent years of work experience
  • 3+ 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
  • 2+ years of experience in a healthcare setting with knowledge of the medical claims and/or billing process
  • 2+ years of experience in writing letters to consumers in all levels
  • Experience with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.

Soft Skills:
  • Strong written communication skills including advanced skills in grammar and spelling
  • Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
  • Strong attention to detail and accuracy

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work. SM

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

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 health care. 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.

Keywords: Healthcare, Managed Care, Appeals, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing, hiring immediately, #RPO

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