Appeals Representative Associate

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.

UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It’s that simple . . . and it’s that rewarding. 

In providing consumer – oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth. 

Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast – paced and highly diversified career.

Flexible, Friendly, fast on your feet, that’s a great start. Accurate, Accountable, Self-Directed; These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It’s complex, detailed work. It’s fast paced challenge. It’s a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances.

This is a full-time position (40 hours/week), Monday through Friday. Employees are required to work our normal business hours of 8:00 AM – 5:00 PM in your time zone. It may be necessary, given the business need, to work occasional overtime.

We offer 4-6 weeks of training. The hours of the training will be Monday through Friday 7 am-3 pm CST. Depending on how quickly the candidate picks up claims processing. Then mentors will be assigned who they will shadow after training and who will serve as a resource moving forward.

 

Primary Responsibilities:

• Research and resolve written complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.
• Communicate with appropriate parties regarding appeals and grievance issues, implications and decisions.
• Analyze and identify trends for appeals and grievances.
• Apply knowledge/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.

 

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 years of 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
• Experience with Microsoft Word (create, edit, format documents) and Microsoft Excel (create, edit, format spreadsheets)
• Ability to work an 8-hour shift during our normal business hours of 8:00am to 5:00pm in your time zone, Monday-Friday

 

Preferred Qualifications:

• 2+ years of medical claims experience
• Experience with Healthcare/Medicare Terminology
• Managed Care and previous Appeals/Grievances experience

 

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. 

 

*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 $16.00 – $27.69 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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