Top 44 Claims representative Jobs in Albuquerque, Nm

Appeals and Grievances Coordinator
UnitedHealthcare —Albuquerque, NM
- $60,200 - $107,400 a year
- Overtime
- Remote
- 18 years or older
- Pass drug screening
- Research
7d
Program Integrity Coordinator (HCA/MAD #10118671)
State of New Mexico —Albuquerque, NM
- $27.37 - $41.06 an hour
- Full-time
- Research
- Mid-level
- Office
- Health insurance
12d
Bilingual English / Dine Customer Service Advocate
UnitedHealthcare —Albuquerque, NM
- $18 - $32 an hour
- 8 hour shift
- Remote
- 18 years or older
- Sales
- Computer literacy
- Paid training
5d
RCM / Medical Billing Specialist
Workit Health —Albuquerque, NM
- $25 an hour
- Full-time
- Hybrid work
- Microsoft Word
- Writing skills
- HIPAA
- Paid parental leave
- Health savings account
Quick Apply
8d
Medical Only Claim Representative I
CCMSI —Albuquerque, NM
- $20 an hour
- Full-time
- Hybrid work
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Paid holidays
- Disability insurance
Patient Access Specialist
Ensemble RCM LLC —Albuquerque, NM
- $17.00 - $18.15 an hour
- Part-time
- Hospital
- Customer service
- High school diploma or GED
- Tuition reimbursement
Investment Advisor Representative / Insurance Agent
Farm Bureau Financial Services —Rio Rancho, NM
- $85,000 - $125,000 a year
- Contract
- Hybrid work
- Background check
- Mid-level
- Office
- Professional development assistance
- Flexible schedule
Quick Apply
14d
Medical Claims Appeals Specialist
New Mexico Cancer Center —Albuquerque, NM
- Full-time
- Background check
- Surgery
- Computer literacy
- Health insurance
- Dental insurance
Quick Apply
Claims - Field Claims Representative
The Cincinnati Insurance Companies —Albuquerque, NM
- $55,000 - $90,000 a year
- Day shift
- Mid-level
- Driver's License
- Bachelor's degree
- Paid time off
- 401(k) matching
Customer Service Representative - State Farm Agent Team Member
Rachel Bloom - State Farm Agent —Albuquerque, NM
- $45,000 - $55,000 a year
- Full-time
- Sales
- Office
- Communication skills
- Opportunities for advancement
Quick Apply
Work from Home - Pharmacy Tech Support/Call Center Rep (10a-7p ET) - National
IQVIA —Albuquerque, NM
- $18 an hour
- Full-time
- Remote
- Spanish
- HIPAA
- English
- Work from home
5d
Independent Contractor Daily Property Field Adjuster/ Surrounding Albuquerque/north NM
Alacrity Claims Solutions, LLC —Albuquerque, NM
- Contract
- Mid-level
- Travel
- Computer skills
Quick Apply
Central Billing Representative I
First Choice Community Healthcare INC —Albuquerque, NM
- Weekends as needed
- Writing skills
- HIPAA
- Clinic experience
14d
Central Billing Representative II
First Choice Community Healthcare INC —Albuquerque, NM
- Monday to Friday
- Word processing
- Writing skills
- HIPAA
4d
Bi-lingual Pharmacy Tech Support/Call Center Rep (Remote Work from Home)
IQVIA —Albuquerque, NM
- $18 an hour
- Full-time
- Remote
- Spanish
- HIPAA
- English
- Work from home
7d
Contact Center Rep
Systems Integration, Inc. —Albuquerque, NM
- Seasonal
- Remote
- Background check
- Computer literacy
- High school diploma or GED
- Paid training
Quick Apply
Claims Specialist- Journal Center, (784)
TriCore Reference Laboratories —Albuquerque, NM
- Full-time
- Current TB test
- Mid-level
- 3 years
Claims Specialist-Journal Center, (783)
TriCore Reference Laboratories —Albuquerque, NM
- Part-time
- Current TB test
- Mid-level
- 3 years
Commercial Insurance Account Manager I
HUB International —Albuquerque, NM
- Full-time
- Hybrid work
- Mid-level
- Office
- High school diploma or GED
Customer Service Representative - State Farm Agent Team Member
Paul Gallegos - State Farm Agent —Albuquerque, NM
- $15 - $20 an hour
- Part-time
- Spanish
- Office
- Communication skills
- Health insurance
- 401(k)
Quick Apply

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Appeals and Grievances Coordinator

UnitedHealthcare -
Albuquerque, NM

Apply Now

Job Details

Full-time
$60,200 - $107,400 a year
7 days ago

Qualifications

Court hearing assistance
Appeals
Customer communication
Legal presentation of evidence
Spreadsheets
Direct client contact
Patient complaint handling
Medical insurance appeals management
Productivity software
Insurance claims appeal handling
Medical terminology
Administrative law
Customer complaint resolution

Full Job Description

This position is Remote in New Mexico. You will have the flexibility to work remotely* as you take on some tough challenges.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

As an Appeals & Grievances Coordinator (A&G) - you will be the health plan representative responsible for managing complex member grievances and appeals, including coordination of requests for state fair hearings. The G&A manager is qualified by training and experience to process and resolve grievances and appeals and is responsible for the grievance system. Will live and work in New Mexico.

This position is full time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

Analyze/research/understand how a service/procedure/authorization was processed and why it was denied/modified
Obtain relevant medical records to submit appeals or grievance for additional review, as needed
Leverage appropriate resources to obtain all information relevant to the claim modified or denied service
Obtain/identify contract language and processes/procedures relevant to the appeal or grievance
Manage all appeals and grievance concerns and priorities within the UHC Turquoise Care Population
Work with applicable business partners to obtain additional information relevant to the denied/modified service (e.g. Utilization Management/Prior Authorization)
Ensure that members obtain a full and fair review of their appeal or grievance
Track and manage requests for all State Fair Hearings; attend and submit evidence regarding cases
Notify members of determination who have Expedited Appeals; when applicable
Document final determination of appeals or grievances using appropriate templates, communication processes, etc. (e.g., response letters, Customer Service documentation)
Acts as liaison with regulatory agencies regarding member grievances and appeals
Understand and adhere to applicable documentation handling policies and regulations (e.g., document security, retention)
Report validation tasks, including reviewing data for accuracy, completeness, consistency, and compliance with applicable state, federal, contractual, and submission requirements
Perform as a solid independent contributor
Assist with validation of monthly/quarterly State appeal and grievance reporting

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 OR equivalent work experience
Must be 18 years of age OR older
2+ years of experience managing the end-to-end appeals, grievances, OR member complaint resolution process
Experience gathering documentation and presenting case facts to Administrative Law Judge at state fair hearings
Experience producing clear, grammatically accurate written correspondence and translating complex medical and insurance terminology into easy-to-understand language for members
Experience working directly with customers, clients, OR members in a service-oriented environment
Proficiency in Microsoft Office applications, including Microsoft Excel, Microsoft Word, Microsoft PowerPoint, and reporting tools
Reside in the state of New Mexico
Ability to travel up to 10% throughout the state of New Mexico
Ability to work full time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

Experience with Medicaid and managed care
Experience working with state partners
Health plan experience

Telecommuting Requirements:

Reside within New Mexico
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO

Apply Now

Refine Your Search

claims representative jobs in albuquerque, nm

Appeals and Grievances Coordinator

Program Integrity Coordinator (HCA/MAD #10118671)

Bilingual English / Dine Customer Service Advocate

RCM / Medical Billing Specialist

Medical Only Claim Representative I

Patient Access Specialist

Investment Advisor Representative / Insurance Agent

Medical Claims Appeals Specialist

Claims - Field Claims Representative

Customer Service Representative - State Farm Agent Team Member

Work from Home - Pharmacy Tech Support/Call Center Rep (10a-7p ET) - National

Independent Contractor Daily Property Field Adjuster/ Surrounding Albuquerque/north NM

Central Billing Representative I

Central Billing Representative II

Bi-lingual Pharmacy Tech Support/Call Center Rep (Remote Work from Home)

Contact Center Rep

Claims Specialist- Journal Center, (784)

Claims Specialist-Journal Center, (783)

Commercial Insurance Account Manager I

Customer Service Representative - State Farm Agent Team Member

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