Appeals Representative - National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.In this role, you should be able to work independently with minimal support from leaders. Work higher volume but requires less effort and less time spent working it. Holding accountability in all of the task and work conducted. Must be deadline driven and detail oriented.This position is full-time (40 hours/week). 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 local time, Monday – Friday. It may be necessary, given the business need, to work occasional overtime or weekends.We offer weeks of on-the-job training. The hours during training will be an 8-hour shift between 8:00am to 5:00pm, Monday - Friday.You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:

Research and resolve written appeals submitted by members and providers

Ensure appeal has been categorized correctly

Obtain additional documentation required for case review

Review case to determine if review by clinician is required

Render decision for administrative appeals using sound, fact-based decision making

Complete necessary documentation of final appeals determination using appropriate templates

Send written appeal resolution to members or providers and internal/external parties within the required timeframes

Ability to manage inventory of appeals in a fast-paced environment with deadlines, and competing priorities

Must have exceptional multi-tasking skills with the ability to prioritize tasks.

Manage assigned inventory to ensure timely and accurate resolution of cases.

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.Required 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 in an office environment using the telephone and computer as the primary instruments to perform job duties

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 any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm local time, Monday – Friday. It may be necessary, given the business need, to work occasional overtime or weekends

Preferred Qualifications:

Experience with ISET, ICUE and/or LINX is highly desired

Familiarity with Managed Behavioral Health Terminology

Behavioral Health Claims experience

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 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 PolicyCalifornia, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: The hourly range for this is $16.54 - $32.55 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.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.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.#RPO