UnitedHealth Group Senior Appeals Representative - Dublin, OH in DUBLIN, Ohio

Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how United Health Group became a Fortune 6 leader in healthcare. We did it by working to become an undisputed leader in creating service quality and helping to improve the lives of millions. Now, here’s where you come in. You can build on your problem solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You’ll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we’ll provide you with great training, support and opportunities.

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 (6:00am-5:30pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 5900 Parkwood Place, Dublin, OH 43016.

There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application. Once you submit your completed application, you will receive an e-mail with information regarding next steps including any pre-employment assessment(s) that are required. Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: http://uhg.hr/OurApplicationProcess

Primary Responsibilities

  • Research and resolve writtencomplaints submitted by consumers and physicians/providers

  • Ensure complaint has beencategorized correctly

  • Obtain additional documentationrequired for case review

  • Review case to determine ifreview by clinician is required

  • Render decision fornon-clinical complaints using sound, fact-based decisionmaking

  • Complete necessarydocumentation of final appeals or grievance determination using appropriatetemplates

  • Communicate appeal or grievanceinformation to members or providers and internal/external parties within therequired timeframes

This is a challenging role with serious impact. You’ll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. You’ll act as a subject matter expert for your team on applicable regulatory guidelines and privacy policies. You’ll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member.


  • 2+ years of experienceanalyzing and solving appeals and grievances in an office environment using thetelephone and computer as the primary instruments to perform job duties OR 2+years of experience in a healthcare setting with knowledge of the medical claimsand/or billing process

  • High school diploma or GED ORequivalent work experience

  • Strong written communicationskills including advanced skills in grammar and spelling

  • Proficiency with computer andWindows PC applications, which includes the ability to navigate and learn newand complex computer system applications

  • Ability to multi-task, thisincludes the ability to understand multiple products and multiple levels ofbenefits within each product

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 bestwork. SM

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work. SM

Diversitycreates a healthier atmosphere: UnitedHealth Group is an Equal EmploymentOpportunity/Affirmative Action employer and all qualified applicants willreceive consideration for employment without regard to race, color, religion,sex, age, national origin, protected veteran status, disability status, sexualorientation, gender identity or expression, marital status, genetic information,or any other characteristic protected by law.

UnitedHealthGroup is a drug-free workplace. Candidates are required to pass a drug testbefore beginning employment.

Key words : Healthcare,Managed Care, Appeals, Billing Representative, Billing, Collections, Claims,Customer Service, Medical Billing