Appeals Representative - Work From Home

Unitedhealth Group Inc. Fairbanks , AK 99701

Posted 2 months ago

If you are located within the state of Alaska, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

Let's talk about diplomacy. Let's talk about accuracy. Let's talk about how UnitedHealth Group became a Fortune 10 company leader in health care. We did it by working to become an undisputed leader in creating quality service and helping to improve the lives of millions. Now, here's where you come in. You can build on your problem-solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You'll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we'll provide you with the great training, support and opportunities you'd expect from a Fortune 10 company.

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 8:00am

  • 5:00pm. It may be necessary, given the business need, to work occasional overtime.

  • 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

  • Ability to work Monday through Friday; 8:00am

  • 5:00pm. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

  • Experience with health care, medical, or pharmacy terminology

Telecommuting Requirements:

  • Reside within state of Alaska

  • 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

Soft Skills:

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

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

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.

Keywords: Healthcare, health care, Managed, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO

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VIEW JOBS 12/27/2021 12:00:00 AM 2022-03-27T00:00 If you are located within the state of Alaska, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. Let's talk about diplomacy. Let's talk about accuracy. Let's talk about how UnitedHealth Group became a Fortune 10 company leader in health care. We did it by working to become an undisputed leader in creating quality service and helping to improve the lives of millions. Now, here's where you come in. You can build on your problem-solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You'll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we'll provide you with the great training, support and opportunities you'd expect from a Fortune 10 company. This position is full-time (40 hours/week) Monday - Friday. 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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 Ability to work Monday through Friday; 8:00am - 5:00pm. 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In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. 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Keywords: Healthcare, health care, Managed, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO Unitedhealth Group Fairbanks AK

Appeals Representative - Work From Home

Unitedhealth Group Inc.