Appeal Resolution Supervisor jobs in Miami, FL

Cuando se trata de salir adelante y tienes la voluntad de ganar, vamos a llamarlo gran potencial de carrera! Imagine being able to get answers to your health plan questions from someone who speaks the same language as you do. Or, the opposite, not being able to get the answers. At UnitedHealth Group, we want our customers to get those answers by speaking to one of our Bilingual Representatives. If you're fluent in English and Spanish, we can show you how to put all of your skills, your passions and your energy to work in a fast - growing environment. 

Opportunities at Change Healthcare, part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing together.  

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.

This position is full-time. 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. 

We offer 4 weeks of paid training. The hours during training will be 8am to 5pm.  

Primary Responsibilities:

• Leads a team of Resolution Specialists responsible for providing high quality client focused services by using knowledge of local, state and federal program requirements to efficiently maintain and update general applicant information to support client applications.
• Responsible for ensuring the quality and quantity of claims taken and ensures that claims are submitted / resolved timely. Ensures that claim status is documented appropriately in the system.
• Review inventory reports and ensure all actions are taken accurately and provide employee feedback.
• Responsible for reporting and metrics for assigned territory. Provides recommendations based on reporting.
• Ensures the appropriate coverage is available within assigned area.
• Monitors and fosters ongoing communications with government agencies regarding the status of claims.
• Manages all customer relationships in accordance with Change Healthcare policy and federal/state regulations.
• Fosters teamwork by actively encouraging team members to work together and by setting the right example.
• Proactively manages change by demonstrating the ability to support innovation and organizational changes needed to improve the organization's effectiveness.
• Manages team performance setting clear goals and expectations, tracking progress against the goals, ensuring feedback, and addressing performance problems and issues promptly.
• Communicates effectively and ensures that information is passed on to others who should be kept informed.
• Develops others by demonstrating the ability to delegate responsibility and to work with others and coach them to develop their capabilities. Ensures that all staff receives the training necessary to be successful.
• Works with the team members on development planning and provides growth opportunities within Change Healthcare as appropriate.
• When staffing needs arise, partners closely with Talent Acquisition to interview and hire the best talent.
• Builds collaborative relationships by developing, maintaining, and strengthening partnerships with others inside or outside the organization who can provide information, assistance, and support.

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
• Must be 18 years of age OR older
• Bilingual fluency in English and Spanish
• 2 years of experience analyzing and solving problems
• 2 years of customer service experience in healthcare, social services, or government/state agencies
• 1 years of experience as a team lead or supervisor, responsible for performance management 
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)
•  Ability to travel up to 10% between local healthcare facilities
• Ability to work onsite at Jackson Memorial, 1611 North West 12th Avenue Miami, FL 33136
• Ability 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. 

Preferred Qualifications:

• Experience tracking employee’s KPI’s (Key Performance Indicators

Soft Skills:

• Strong communication skills
• Strong organizational skills

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: 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.

#RPO #RED