Clinical Appeals Reviewer

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

At United Healthcare, 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.

This position is full-time, 5 days a week, Monday - Saturday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm in your time zone, including the ability to work 2 Saturdays per month (Alternating every other Saturday and the possibility of working on Sundays when needed). It may be necessary, given the business need, to work occasional overtime.

We offer on the job paid training. The hours of training will be 8:00am - 5:00pm in your time zone, Monday - Saturday, or during your normally scheduled shift.
Training will be conducted virtually from your home. Attendance is 100% required for training.

• Provides expertise or general support in reviewing, researching, investigating, and resolving appeals
• Understands the appeals process rules and regulations, including turnaround time and compliance expectations
• Demonstrates great depth of knowledge/skills in own function
• Proactively identifies solutions to non-standard requests
• Solves moderately complex problems on own
• Works with team to solve complex problems
• Maintain accuracy and thoroughness in all applications for data entry

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.

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 1+ years of experience in a healthcare setting with exposure to health insurance processes, claims knowledge, and/OR medical terminology
• 1+ years of experience managing high-volume outbound calls in a fast-paced environment, delivering exceptional customer service while quickly resolving issues and meeting performance targets
• Experience with consistently meeting role expectations, maintaining accountability, and contributing to team and organizational goals
• Data entry experience entering large volumes of data into software systems
• Experience working with Microsoft Office including Microsoft Outlook (ability to create, edit, save, and send documents) and Microsoft Excel (ability to create, edit, save, and send documents)
• Ability to work 5 days a week, Monday - Saturday. Employees are required to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm in your time zone, including the ability to work 2 Saturdays per month (Alternating every other Saturday and the possibility of working on Sundays when needed). It may be necessary, given the business need, to work occasional overtime.

• 1+ years of health insurance appeals experience in a payor environment
• ICD
  10, CPT and HCPCS coding experience
• Medical Terminology knowledge

• 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.

• Strong analytical and research skills that support informed and equitable decision-making
• Clear and respectful verbal and written communication that fosters understanding across diverse audiences
• Consistent delivery of high-quality results while promoting collaboration and continuous improvement
• Active listening and information gathering to address immediate needs and anticipate future opportunities
• Collabor…