Job Information
UnitedHealth Group Senior Appeals Representative in Letterkenny, Ireland
Senior Appeals Representative – Letterkenny (Fully office-based)
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
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.
You will 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 providing development for other roles you may be interested in.
Required Qualifications:
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.)
Preferred Qualifications:
Experience in processing healthcare/insurance claims
Experience of the USA health system
Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.
The successful candidates will be taken through a comprehensive 6–8-week training course during which the expectation is that annual leave will not be available for the duration .
For more information on our Internal Job Posting Policy, click here.
All telecommuters will be required to adhere to the UnitedHealth Group’s Telecommuter Policy.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2023 Optum Services (Ireland) Limited. All rights reserved.