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

At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone.

LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system. LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life’s best work.^SM

The Accounts Payable Provider - Reimbursement Specialist is responsible for investigating and processing appeals and grievances received by veterans or providers. This is a challenging role with serious impact, Specialist work collaboratively with other internal and external functional areas and stakeholders as necessary to resolve the case within the allocated timeframes. 

This position is full-time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am - 5:30pm CST. It may be necessary, given the business need, to work occasional overtime. 

We offer 2-4 weeks of paid training. The hours during training will be 8:00am to 4:30pm CST, Monday - Friday. Training will be conducted virtually from your home.

Primary Responsibilities: 

• Analyze/research/understand how a claim was processed and why it was denied
• 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
• Identify and obtain additional information needed to make an appropriate determination
• Obtain/identify contract language and processes/procedures relevant to the appeal or grievance
• Work with applicable business partners to obtain additional information relevant to the claim (e.g., Network Management, Claim Operations, Enrollment, Subrogation)
• Determine whether additional appeal or grievance reviews are required (e.g., medical necessity), and whether additional appeal rights are applicable
• Determine where specific appeals or grievances should be reviewed/handled, and route to other departments as appropriate

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 experience 
• Must be 18 years of age or older
• 2 years of experience processing medical and or dental claims
• 1 years of experience with PCs and Microsoft office, including Outlook (calendar management, sending correspondence), Word (drafting, sending and saving documents), Excel (basic formulas, creating and sending spreadsheets) and Power Point (creating, sending and saving presentations)
• Superior Customer Service
• Ability to work independently
• Exceptional phone etiquette skills
• Exceptional time management skills
• Ability to create professionally written emails to providers
• Ability to work any of our 8-hour shift schedules during our normal business hours of 6:00am - 5:30pm CST. It may be necessary, given the business need, to work occasional overtime. 

Preferred Qualifications:

• Applies knowledge/skills to a range of moderately complex activities
• Demonstrates great depth of knowledge/skills in own function
• Acts as a technical resource (sometimes) to others in own function
• Proactively identifies solutions to non-standard requests
• Ability to solve moderately complex problems on own
• Works with team to solve complex problems
• Plans, prioritizes, organizes, and completes work to meet established objectives
• Coordinate work of another team member

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 UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

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.

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.

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