Appeals Representative - National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This position is full time, 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.

We offer 4 weeks of paid on-the-job training. The hours of training will be aligned with your schedule during normal business hours.

You’ll enjoy the flexibility to telecommute

• from anywhere within the U.S. as you take on some tough challenges.

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 timeframes

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

Must be 18 years of age OR older

1 years of experience with analyzing and solving customer problems

Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

Experience with Microsoft Word (create correspondence and work within templates) and Microsoft Outlook (email and calendar management)

Ability to work any of our shift schedules during our normal business hours of 8 : 00 AM - 5 : 00 PM from Monday - Friday

Preferred Qualifications :

Experience with health care, medical, OR pharmacy terminology

Experience in working with Microsoft Excel (data entry, sort / filter, and work within tables)

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

Soft Skills :

The hourly range for this role is $16.88 to $33.22 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.

Salary : $17 - $33