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Appeals Rep- United Health Group

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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 and start doing your life’s best work.SM

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

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 (or higher) OR equivalent years of work experience
  • 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 the primary job tools
  • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

Preferred Qualifications:

  • Experience with health care, medical, or pharmacy terminology

Soft Skills:

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

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we’re presented with an opportunity to make a difference on a scale we couldn’t imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you’ll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You’ll help write the next chapter in the history of healthcare. And you’ll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work.SM

California, Colorado, Connecticut, Nevada, Washington or New York, Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $16.00 – $31.44.Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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

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.