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