OON Dispute Coordinator / Intake

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The newly created Out of Network (OON) Dispute Resolution team is responsible for end-to-end resolution of regulated OON disputes/arbitrations across UHC commercial lines of business on a variety of platforms.

This team will expand significantly due to the No Surprises Act section of the federal 2021 Consolidated Appropriations Act. As a key member of the OON Dispute Resolution team, this position provides administrative support for the team and interacts with internal and external contacts. Independent thinking and sound judgment are required. Meeting an established production, turnaround time and quality standard is required. Responsible for a variety of duties that are critical to the success of OON Disputes, including:

Daily Responsibilities:

• Monitor group mailboxes for new inventory volume

• Monitor claim routing systems for new inventory (ORS, ACET, MACESS)

• Document all mail/fax/electronic issue receipt in tracking tool

• Identify correct handling for each receipt

• Update disputes in timely manner to appropriate status

• Create and submit expense reports for the administrative and arbitor fees via Concur Expense

• Pay invoices and update tracking tool as appropriate

• Interface with regulators in providing status and other information as requested concerning OON disputes

• Interface with providers regarding status and other information as requested concerning OON disputes

• Work in a collaborative manner with all members of the OON Dispute Resolution team to ensure the successful attainment of departmental goals

• Complete database updates as directed

• Use strong written and verbal skills to clearly and professionally communicate with regulatory agencies and internal business partners

• Follow established Process and Procedures and ensure dispute has been categorized correctly

• Provide exceptional service to our internal/external, and regulatory contacts always

• Prioritize and organize tasks to meet established productivity, schedule adherence, and quality standards

• Ability to complete some work without established procedures

• Ability to complete basic tasks without review by others

• Ability to recognize when complex review requires Supervisory guidance or SME support

• Complete systems and related training to serve as a back up to the OON Analyst

• Other duties as identified

Daily Practices:

• Ability to communicate effectively and professionally · Ability to learn new systems quickly

• Attention to detail

• Ability to analyze regulatory statutes to ensure compliance with state laws regarding claim processing

• Excellent organizational skills

• Excellent interpersonal skills

• Positive attitude

• Team player

• Ability to work independently

• Ability to make sound decisions in a fast-paced environment

• Quality orientation

• Demonstrated ability to work effectively with key customers, and peers

• Ability to utilize multiple systems

• Ability to work under time constraints

• Ability to prioritize and meet deadlines

• Strong interpersonal and oral communication skills

• Strong, demonstrated independent and critical thinking skills

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 or GED

• 1 year of Managed care or medical insurance experience

• Basic level of proficiency with MS Excel, Word and Outlook

Preferred Qualifications:

• Demonstrated proficiency in routing, reviewing, and managing items in: ORS, MACESS, or ACET

• Working knowledge and experience reviewing claims in UNET, FACETS CSP, or USP

• Knowledge of State and Federal Regulations governing health benefit plans

• UHG organizational, system and policy knowledge Critical Success Factors

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
 

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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.SM

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $16.00 to $26.88. The salary range for Connecticut / Nevada residents is $16.83 to $29.66. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives 

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: #RPO, wah, wfh, remote