Senior Appeals Representative
UnitedHealth Group
- Letterkenny, Co Donegal
- Permanent
- Full-time
As a Fortune 5 business, we’re one of the world’s leading healthcare companies. There are no limits here on the resources you’ll have or the challenges you’ll encounter.We have been supporting global healthcare systems from Ireland and the UK for more than 20 years, building a dynamic and diverse team of more than 2,100 talented individuals. With a continued record of growth and stability, we're on the constant lookout for fresh talent to join our expanding teams.As a Senior Appeals Representative you will be 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, to clearly understand and resolve the reason for the appeal. The Senior Appeals Representative is 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.). Working alongside the team supervisors you’ll have the opportunity to Deliver world class customer service, In addition to having impact on a great team, you'll also discover the career opportunities you'd expect from an industry leader.Working Schedule:This is a full-time position working fully onsite from our Letterkenny office, in order to be considered for this role you must be able to commute to the site reliably from Monday – Friday.Primary 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.
- Maintain confidentiality of member appeals information per HIPPA regulations
- Understand and adhere to applicable documentation handling policies and regulations.
- 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, etc.)
- Experience in processing healthcare/insurance claims
- Experience of the USA health system