Appeals Representative

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 UnitedHealthcare, 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position is full-time (40 hours/week), Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer 6-8 weeks of paid training. The hours during training will be 8:00am – 4:30pm, Monday – Friday (subject to change depending on trainer’s availability). Training will be conducted virtually from your home.

 

Primary Responsibilities:

• Classify, research, and understand providers intent to appeal decision
• Status provider as PAR (participating) or Non-Par (non- participating) and route to correct area that handles the appeal
• Identify and obtain all additional information (relevant medical records, process/procedures) needed to identify provider intent
• Meet the performance goals established for the position in the areas of efficiency, utilization, accuracy, and attendance
• Work with multiple systems included but not limited to COSMOS, CPA, ODAR, DDE, FACETS, MACESS, ATS, DOC360, and SOPs
• Works independently with attention to details

 

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 work experience
• Must be 18 years of age OR older
• 1+ years of experience analyzing and solving customer problems OR 1+ years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as primary job tools
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Ability to work full-time (40 hours/week), Monday – Friday, in any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm EST. It may be necessary, given the business need, to work occasional overtime

 

Preferred Qualifications:

• Experience with health care, medical OR pharmacy terminology

 

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:

• Strong written communication skills including advanced skills in grammar and spelling

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 – $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

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