Clinical Appeals Representative - Cypress, CA

If you are in Cypress, CA, you will have the flexibility to work from home and the office in this hybrid role* 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

Positions in this function are responsible for setting up the Appeals and Grievance cases for the Coordinators, Nurses and Doctors to review for a determination of denial. Position consists of reading and analyzing the member's correspondence and determining what the complaint is which could lead to several different issues. The Clinical Appeals Representative needs to be able to distinguish between Quality of Care, Appeal, Grievances, Expedited, Claims, Referral issues and determining exactly what the member is wanting in their letters. Position involves, calling to obtain the correct information from Member, Medical Groups, Providers, and other Departments. Position requires regulatory turnaround times. Accuracy is a very important part of this position.

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 PST. It may be necessary, given the business need, to work occasional overtime.

Our office is located at 5701 Katella Avenue, Cypress, CA, 90630. Employees will be required to work 3 days onsite and 2 days from home, if telecommuting requirements are met.

We offer weeks of on-the-job training. The hours during training will be 8:00am

• 5:00pm PST, Monday

• Friday.

• All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:

• Receive appeal or grievance documentation and determine relevant details (e.g., what member is requesting)

• Enter appeals and grievances details within the system and audit against provided documentation.

• Determine where appeal or grievance should be reviewed / handled or route to other departments as appropriate

• Contact and work with other internal resources to obtain and clarify information

• Complete appeal or grievance review procedures according to relevant regulatory or contractual requirements, processes, and timeframes

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

• 6+ months of Telephonic Customer Service experience

• 35+ WPM typing skills

• Ability to use Microsoft Office

• Microsoft Word (create and edit correspondence), Microsoft Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (VLOOKUP, if), and Microsoft Outlook (email and calendar management)

• Ability to work Monday

• Friday, 8-hour shifts during core business hours of 8:00am

• 5:00pm PST

• Must be 18 years of age or older

• Ability to work onsite at least 3 days a week at the Cypress, CA office

Preferred Qualifications:

• Medical Terminology experience

• Experience in Claims, Managed Care HMO, Doctor's office, and / or Billing

Telecommuting Requirements:

• Reside within commutable distance of our office located at 5701 Katella Avenue, Cypress, CA, 90630

• 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.

California Residents Only: The hourly range for California residents is $16.00 - $28.27 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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