[Hiring] Senior Appeals Representative @UnitedHealth Group

Role Description

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.

As SME you will be doing all end-to-end process. Work independently with support for leaders and members. Should be deadline driven and detail oriented, while holding accountability to all actions. Appeals would be assigned to them all day and pivot if needed. Work higher volume but requires less effort and less time spent working it.

Employees in this position are responsible for:

• Responding, analyzing, and resolving written clinical or administrative appeal requests using the correct process, letter templates, appeal attachments and enclosures within the required timeframes for all level of care for all delegated accounts.
• Managing assigned inventory to ensure timely and accurate resolution of cases.

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 7:00am – 6:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 2-4 weeks of on-the-job training. The hours of training will be 8:00am – 5:00pm, Monday – Friday.

Primary Responsibilities:

• Research and resolve written appeals submitted by consumers and physicians/providers.
• Ensure appeals have 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 appeals 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.
• Must have exceptional multi-tasking skills with the ability to prioritize tasks.

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 act as a subject matter expert for your team on applicable regulatory guidelines and privacy policies. 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.

Qualifications

• High School Diploma / GED OR equivalent work experience.
• Must be 18 years of age OR older.
• 2+ years of experience analyzing and solving appeals and grievances OR 2+ years of experience in a healthcare setting with knowledge of the medical claims and/or billing process.
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications.
• Ability to work 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 7:00am – 6:00pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications

• Behavioral claims or appeals experience.
• Experience using Linx, ISET, ICUE, ACET, CSP Facets, ATS, Doc360, EnterpriseNow.

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

• Extensive work experience within own function.
• Work is frequently completed without established procedures.
• Works independently.
• May act as a resource for others.
• May coordinate others' activities.
• Ability to multi-task, including understanding multiple products and multiple levels of benefits within each product.
• Strong written communication skills including advanced skills in grammar and spelling.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

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.