Appeals Coordinator - San Francisco, CA

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.



United Behavioral Health, a UnitedHealth Group company, is a leading provider of emotional wellness services. Currently serving over 22 million Americans, our innovative solutions include behavioral health, employee assistance, work/life and pharmacy management services, as well as a unique disability support program. We offer specialized, confidential support to help our members live and work well, and excellent resources and rewards for your career so you can do the same. A healthy business awaits you at UBH. 


 


Job Responsibilities:



Position responsible for researching and resolving and responding to appeals from members and/or providers regarding claims and benefit administration.


Log and track all written appeals received and to assure written acknowledgment and resolution within corporate guidelines.


Assure that responses and appeal resolutions time frames meet specific client performance guarantees.


Analyze, research and resolve appeal requests through review of benefit design, eligibility, care management procedures and claims payments as they relate to the identified issues.


Communicate with appropriate departments to assure accurate and complete research.


Communicate in writing with appropriate parties regarding appeals and grievance decisions.


Coordinate the grievance process and communicate the issues and implications verbally and in writing to all participants.


Produce and distribute monthly internal reports and other state reports as required by mandates.


All other duties as required.



Job Qualifications:


Successful candidate will have extensive claims and customer service experience in an HMO or insurance environment.

Excellent research and written and verbal communication skills required.

Must be able to work independently and manage priorities.

Requires proficiency in Word and Excel.


Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.