Senior Appeals Representative

Overview

Senior Appeals Representative role at United Healthcare. This position is National Remote. You’ll have the flexibility to telecommute from anywhere within the U.S. while handling challenging tasks.

At United Healthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do impacts the lives of millions. Join us to help build a more responsive, affordable, and equitable health care system.

This is a full-time role (40 hours/week) with an 8-hour shift schedule during normal business hours of 7:00am – 7:00pm EST. The department is open 365 days a year and occasional overtime may be necessary.

We offer six weeks of paid training. Training hours are 8:00am to 4:30pm EST, Monday – Friday. Training will be conducted virtually from your home.

• Research and resolve written complaints submitted by consumers and physicians/providers
• Ensure complaints are categorized correctly
• Obtain additional documentation required for case review
• Review cases to determine if clinician review is required
• Render decisions for non-clinical complaints using sound, fact-based judgment
• Complete necessary documentation of final appeals or grievance determinations using appropriate templates
• Communicate appeal or grievance information to members, providers, and internal/external parties within required time frames

This role requires strong analytical skills and the ability to collaborate with other departments to obtain original claims processing details. You’ll serve as a subject matter expert on applicable regulatory guidelines and privacy policies.

• High School Diploma / GED or equivalent work experience
• Must be 18 years of age or older
• 2+ years of experience analyzing and solving appeals and grievances in an office environment using telephone and computer, or 2+ years in a healthcare setting with knowledge of medical claims and/or billing
• Experience with Microsoft Word and Excel
• Proficiency with computer and Windows PC applications
• Ability to work full-time (40 hours/week) Monday – Saturday with flexibility to cover required shifts 7:00am – 7:00pm EST; department open 365 days a year; occasional overtime may be necessary

• Maintain security of all company sensitive documents (where applicable)
• Must have a dedicated work area that is private and separate from living/workspace
• Must live in a location with access to United Health Group approved high-speed internet

• Strong written communication skills with advanced grammar and spelling
• Ability to multi-task and understand multiple products and levels of benefits
• Adherence to United Health Group’s Telecommuter Policy

Pay is based on factors including location, education, experience, and certifications. The hourly pay range is $20.00 - $35.72 per hour for full-time employment. We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions (eligibility applies).

All benefits are subject to eligibility requirements. We comply with minimum wage laws where applicable.

Final date to receive applications: This job posting will be posted for a minimum of 2 business days or until a sufficient candidate pool is collected. It may be pulled early due to volume of applicants.

United Health Group is an Equal Employment Opportunity employer. We are committed to mitigating our impact on the environment and delivering equitable care. We operate a drug-free workplace; candidates must pass a drug test before employment begin.

• Seniority level:
  Entry level
• Employment type:
  
  Full-time
• Job function:
  Other
• Industries:
  Hospitals and Health Care

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