UMR Appeals Representative

National Remote Position

You'll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

UMR, United Healthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple and it's that rewarding.

In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.

Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast-paced and highly diversified career.

This is a full-time position (40 hours/week), Monday through Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm in your time zone. It may be necessary, given the business need, to work occasional overtime.

Training will be up to 10 weeks. The hours during training will be 7:00am to 3:00pm CST, Monday - Friday.

Primary Responsibilities:

• Research and resolve written complaints submitted by consumers and physicians/providers
• Ensure complaint has been categorized correctly
• Obtain additional documentation required for case review
• Review case to determine if review by clinician is required
• Render decision for non-clinical complaints using sound, fact-based decision making
• Complete necessary documentation of final appeals or grievance determination using appropriate templates
• Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframe

This is a challenging role with serious impact. You'll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. You'll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member.

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
• 1+ years of current OR previous claims processing or appeals experience within the healthcare industry
• 1+ years of customer service experience with analyzing and solving customer problems
• 1+ years of experience with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• This is a full-time position (40 hours/week), Monday through Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm in your time zone. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Experience with healthcare, medical, OR pharmacy terminology

Telecommuting Requirements:

• 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 United Health Group approved high-speed internet connection or leverage an existing high-speed internet service (UHG requires a wired internet connection: cable, DSL or fiber internet service with Minimum speed standard of 25 Mb download/10-15 Mb upload. Wireless services such as satellite, hot spot, line of sight antenna cannot be used for telecommuting.)

* All employees working remotely will be required to adhere to United Health 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 hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Final date to receive applications:
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 United Health Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every…