Clinical Appeals Reviewer - Remote
Company: UnitedHealth Group
Location: Hartford
Posted on: May 8, 2022
Job Description:
You'll enjoy the flexibility to telecommute* from anywhere
within the U.S. as you take on some tough challenges. Welcome to
one of the toughest and most fulfilling ways to help people,
including yourself. We offer the latest tools, most intensive
training program in the industry and nearly limitless opportunities
for advancement. Join us and start doing your life's best
work.SMPositions in this function are responsible for providing
expertise or general support to teams in reviewing, researching,
investigating, negotiating, and resolving all types of appeals and
grievances. Communicates with appropriate parties regarding appeals
and grievance issues, implications, and decisions. Analyzes and
identifies trends for all appeals and grievances. May research and
resolve written Department of Insurance complaints and complex or
multi-issue provider complaints submitted by consumers and
physicians/providers.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 9am - 6pm CST. It may be necessary, given the business need, to
work occasional overtime.*All Telecommuters will be required to
adhere to UnitedHealth Group's Telecommuter Policy.Primary
Responsibilities:
- Ensure complaint has been categorized correctly
- Determine and confirm member eligibility and benefits
- Obtain additional documentation required for case review
- Place relevant documents into image repository
- Initiate outbound contact to members or providers
- Review case to determine if review by Clinician is
required
- Research and resolve written complaints submitted by consumers
and physicians/providers
- Render decision for non-clinical complaints using sound,
fact-based decision making
- Prioritize and organize tasks to meet compliance deadlines
- Ability to meet established productivity, schedule adherence,
and quality standards
- Moderate work experience within own function
- Some work is completed without established procedures
- Basic tasks are completed without review by others
- Supervision/guidance is required for higher level tasksYou'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 higher)
- 2+ years of telephonic customer service experience
- Available to work an 8 hour shift 5 days a week from 9:00 am
6:00 pm CSTPreferred Qualifications:
- Intake experience
- Experience working on Appeals
- Experience with ECAA, Adhoc, iCare, and Client
LetterTelecommuting Requirements:
- Required to have a dedicated work area established that is
separated from other living areas and provides information
privacy
- Ability to keep all company sensitive documents secure (if
applicable)
- Must live in a location that can receive a UnitedHealth Group
approved high-speed internet connection or leverage an existing
high-speed internet serviceUnitedHealth Group requires all new
hires and employees to report their COVID-19 vaccination
status.Military & Veterans find your next mission: We know your
background and experience is different and we like that.
UnitedHealth Group values the skills, experience and dedication
that serving in the military demands. In fact, many of the values
defined in the service mirror what the UnitedHealth Group culture
holds true: Integrity, Compassion, Relationships, Innovation and
Performance. Whether you are looking to transition from active duty
to a civilian career, or are an experienced veteran or spouse, we
want to help guide your career journey. Learn more at Learn how
Teresa, a Senior Quality Analyst, -works with -military veterans
and ensures they receive the best benefits and experience possible.
-Careers with UnitedHealthcare. Let's talk about opportunity. Start
with a Fortune 10 organization that's serving more than 85 million
people already and building the industry's singular reputation for
bold ideas and impeccable execution. Now, add your energy, your
passion for excellence, your near - obsession with driving change
for the better. Get the picture? UnitedHealthcare is serving
employers and individuals, states and communities, Military
families and Veterans wherever they're found across the globe. We
bring them the resources of an industry leader and a commitment to
improve their lives that's second to none. This is no small
opportunity. It's where you can do your life's best
work.SMColorado, Connecticut or Nevada Residents Only: The salary
range for Colorado residents is $15.00 to $25.19. The salary range
for Connecticut / Nevada residents is $15.77 to $27.79. Pay is
based on several factors including but not limited to education,
work experience, certifications, etc. 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.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.Keywords: #RPO, #YELLOW
Keywords: UnitedHealth Group, Hartford , Clinical Appeals Reviewer - Remote, Healthcare , Hartford, Connecticut
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