Appeals Representative

UnitedHealth Group • Tampa, FL • 2h ago

Requisition number: 2382210

Job category: Claims

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.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

This position is full-time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

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

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 years of work experience

Must be 18 years of age OR older

1+ years of experience with analyzing and solving customer problems

1+ years of experience working in a remote environment

Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

Experience with Microsoft Word (create correspondence and work within templates) and Microsoft Outlook (email and calendar management)

Ability to work between the hours of 7:00 am - 5:00 pm MST from Monday - Friday

Preferred Qualifications:

Experience with health care, medical, OR pharmacy terminology

Experience working with Microsoft Excel (data entry, sort / filter, and work within tables)

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 with advanced proficiency 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 $18 - $32 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.

Similar Jobs

Manager Nursing Endo

HCA Healthcare • Brandon, FL • 35min ago

Hospital & Medical

This position is incentive eligible. Stroke response times nearly half of the national average. Cutting-edge SPOT Technology that detects sepsis earlier than the human eye. An Enhanced Surgical Recovery program that redu...

35min ago

Go to Apply

Assistant Manager I

Family Dollar • Saint Petersburg, FL • 49min ago

Retail & Hospitality

We're seeking an Assistant Store Manager to join our team to help with store operations, customer service and team development. Duties include, but are not limited to, the following: Assist with store functions and day-t...

49min ago

Go to Apply

Assistant Store Manager - Full-Time

PVH Corp. • Lutz, FL • 56min ago

Retail & Hospitality

Be part of an iconic story. TOMMY HILFIGER is one of the world's most recognized global lifestyle brands, confidently welcoming and inspiring consumers since 1985. Originally established in New York City and infused with...

56min ago

Go to Apply

Anesthesia Technician

HCA Healthcare • Trinity, FL • 2h ago

Hospital & Medical

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Anesthesia Technician today with HC...

2h ago

Go to Apply

Apprentice Carpenter

Ultimate LLC • Holiday, FL • 2h ago

Apprentice Carpenter - Holiday, FL Pay: $23-$25/hour Schedule: Monday-Friday, 7:30 AM - 4:00 PM Start Date: ASAP Job Overview Seeking two Apprentice Carpenters to support the renovation and conversion of motel units into...

2h ago

Go to Apply

All- Source Analyst

General Dynamics Information Technology • Tampa, FL • 2h ago

Req ID: RQ226734 Type of Requisition: Regular Clearance Level Must Be Able to Obtain: Top Secret/SCI Public Trust/Other Required: None Job Family: Intelligence Operations and Analysis Skills: Analytical Support,Communica...

2h ago

Go to Apply

Appeals Medical Director - Onc/Rad-Onc/EM/IM/Optho Required - Remote

UnitedHealth Group • Tampa, FL • 4h ago

Hospital & Medical

Requisition number: 2341234 Job category: Medical & Clinical Operations At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The wor...

4h ago

Go to Apply

CT Tech

Health Advocates Network • Tampa, FL • 4h ago

Hospital & Medical

Benefits We Offer: Comprehensive health, prescription, dental, vision, life, and disability plans Competitive pay rates Referral opportunities ? Refer a friend & Cash in! Travel reimbursement and per diem allowances...

4h ago

Go to Apply

ABD/OB Sonographer

Health Advocates Network • Largo, FL • 4h ago

Hospital & Medical

4h ago

Go to Apply

Director, Clinical Pharmacy Strategy - Medical Drugs

Elevance Health • Tampa, FL • 4h ago

Hospital & Medical

Director, Clinical Pharmacy Strategy - Medical Drugs Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity...

4h ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)