Pr Job in San Juan, : PR
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Appeals & Grievances Supervisor - San Juan, Pr
Appeals & Grievances Supervisor - San Juan, Pr Job Description
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 appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyzes and identifies trends for all appeals and grievances. May research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.
- 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
- Owns output at task level
- Sets priorities for the team to ensure task completion
- Coordinates work activities with other supervisors
- 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
*** ENGLISH PROFICIENT ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***
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.
- Associate Degree or equivalent credits approved (60 credits)
- 1+ year healthcare industry experience
- 1+ year of previous leadership experience as a: SME, Trainer, Team Lead or Supervisor.
- Experience with Microsoft Tools: Microsoft Word (creating memos, writing), Microsoft Outlook (setting calendar appointments, email) and Microsoft Excel (creating/editing spreadsheets, filtering, navigating reports)
- Ability to work 40 hours / week during standard business operating hours Monday - Friday from 6am - 6pm AST
- English & Spanish proficiency (verbal and written)
- You will be asked to perform this role in an office setting or other company location.
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
- Bachelor’s degree or higher
- Claims Experience
- Experience in processing adjustments
- Experience with healthcare/medical terminology
- Working knowledge of Medicaid claims filing experience
- Working knowledge of Cosmos/CSP Facets platforms
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to 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.
Job Keywords: Appeals Supervisor, Customer Service Supervisor, Appeals Leadership, San Juan, Puerto Rico, PR
San Juan Pr Job