Job Detail

Appeals Representative - Cypress, CA or Work From Home UnitedHealth Group 5701 Katella Av, Cypress, CA 90630 Remote Full-time, Part-time - Medical Billing & Coding

Date Posted: Dec 06, 2021

Job Description

Job details

Job Type
Pulled from the full job description
Work from home
Vision insurance
Opportunities for advancement

Full Job Description

If you are located within Chico, CA, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. If you are located in Cypress, CA, you will work onsite at the office location.

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

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work 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 5701 Katella Avenue, Cypress, CA 90630

.*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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.

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

    • Proficiency with computer and Windows PC applications, including MS Office (Word (creating, editing, saving and sharing documents), Excel (creating, saving, editing, sharing files, using formulas) and Outlook (creating rules and using calendar, create, copy, edit, save and send correspondence)) and the ability to navigate and learn new and complex computer system applications

    • Ability to work Mandatory overtime between 1 to 20 hours per week as needed

    • Previous experience with creating resolution letters

  • 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.

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

Telecommuting Requirements:

    • Reside within Chico, CA

    • Required to have a dedicated work area established that is separated from other living areas and provides information privacy

    • Ability to keep all company sensitive documents secure

  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

    • Ability to ask probing questions to identify underlying issues

  • Ability to think analytically

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

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

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers with UnitedHealthcare
. Let's talk about opportunity. Start with a Fortune 5 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 wherever 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

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: appeals, grievances, dental, hiring immediately, Cypress, California, claims, billing, Omega, Webstation, correspondence, Regulatory, FACETS, ETS, ISET, healthcare, UHG, Unitedhealthcare, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO



5701 Katella Av, Cypress, CA 90630

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