Appeals Representative

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.

The Appeals Representative is responsible for research on all the applications and correspondence and then provide resolution for IFP Appeals by reviewing, researching, scrubbing, making outreach to member, provider and resolving all types of appeals and grievances.

Primary Responsibilities:

• Research and resolve written complaints and complex or multi-issue member & provider complaints submitted by consumers and physicians or providers
• Communicate by making outreach calls with appropriate parties (member and or provider) regarding appeals and grievance issues, implications and decisions
• Analyze and identify trends for appeals and grievances
• Apply knowledge or skills to basic, repeated activities
• Respond to standard requests and solve routine problems by following established procedures
• Work with others as part of a team and have work reviewed by others
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Graduate
• Freshers are also eligible with good communication skills and interpersonal skills
• 6+ months of Customer calling Service Experience in a call center environment
• Beginner level of experience with MS Word and Excel.
• Good typing speed (English) and accuracy
• Demonstrated ability of analyzing and solving customer problems OR 1+ year of experience in a corporate environment will be added advantage
• Proven solid verbal and written communication skills
• Proven result-oriented and goal-driven
• Proven critical thinking abilities
• Willing to work night shifts

Preferred Qualifications: 

• Experience with Healthcare or Medicare Terminology
• Managed Care and previous Appeals/Grievances experience

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.