Supervisor Appeals & Grievance / CTM Quality - Any UHG Office or Curre

United Health Group
Oct 15, 2016
Nov 12, 2016
Employer Type
Direct Employer
Employment Type
Full Time
Position Description:

You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.

Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.

Primary Responsibilities:

* Coordinates, supervises and is accountable for the daily activities of team of quality professionals.
* Owns output at task level.
* Sets priorities for the team to ensure task completion.
* Coordinates work activities with other supervisors to ensure production goals are met.
* Develops plans to meet short-term objectives.
* Identifies and resolves operational problems using defined processes, expertise and judgment.
* Decisions are guided by policies, procedures and business plan.
* Builds strong working relationships with Operations Team.
* Use reporting tools to analyze data and identify trends.
* Provides feedback and coaching to team members.
* Tracks performance and addresses performance issues as needed.
* Conducts annual performance reviews for team members.
* Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.
* Impact of work is most often at the team level.
* Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit.
* Impact of work is most often at the team level.

Required Qualifications:

* High School Diploma/GED
* Must be available to work Monday-Friday 7am-6pm CST
* 2+ years of experience in a Supervisor, Team Lead, or SME role
* 2+ years of Appeals & Grievance OR CTM required > Appeals experience MUST BE specificto processing appeals from health plan perspective including: understanding ofthe Centers for Medicare and Medicaid Services (CMS) regulatory compliancerequirements for appeals processing. Grievance experience MUST BE specific toprocessing grievances from a health plan perspective including: understanding ofthe CMS regulatory compliance requirements for grievance processing OR CTM experience WHICH MUST BE SPECIFIC TO Processing Complaints Tracking Modules received from CMS from ahealth plan perspective. Understanding of the CMS regulatory compliancerequirements for handling beneficiary complaints received by CMS.
* 1+ years of experience with Medicare Plans

Preferred Qualifications:

* Undergraduate Degree or Higher or 2+ years of experience in CTM
* Project Management experience preferred

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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.

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.


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