Sr Appeals Representative

UnitedHealth Group Inc.•Tampa, FL

84d•$20 - $36•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. 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 to start Caring. Connecting. Growing together. This position is full-time (40 hours/week) Monday - Saturday. Employees are required to have flexibility to work our 8-hour shift schedule during normal business hours of 7:00 AM to 7:00 PM EST. The Department is open 365 days a year. We offer 6 weeks of paid training. The hours during training will be 8:00am to 4:30pm EST, Monday - Friday. Training will be conducted virtually from your home. 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 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.

Requirements

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 in an office environment using the telephone and computer as the primary instruments to perform job duties OR 2+ years of experience in a healthcare setting with knowledge of the medical claims and/or billing process
Experience with Microsoft Word (create/edit documents); Microsoft Excel (data entry/formatting)
Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
Ability to work fulltime, (40 hours/week) Monday - Saturday. Employees are required to have flexibility to work our 8-hour shift schedule during normal business hours of 7:00 AM to 7:00 PM EST.
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 including advanced skills in grammar and spelling
Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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