Appeals Representative

UnitedHealth Group•Tampa, FL

2d•$18 - $32•Remote

About The Position

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.

Requirements

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
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.
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
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

Experience with health care, medical, OR pharmacy terminology
Experience working with Microsoft Excel (data entry, sort / filter, and work within tables)

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