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Appeals Representative - Central Region - Remote

Company: UnitedHealth Group
Location: Hartford
Posted on: June 23, 2022

Job Description:

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Let's talk about diplomacy. Let's talk about accuracy. Let's talk about how UnitedHealth Group became a Fortune 5 company leader in health care. We did it by working to become an undisputed leader in creating quality service and helping to improve the lives of millions. Now, here's where you come in. You can build on your problem - solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You'll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we'll provide you with the great training, support and opportunities you'd expect from a Fortune 5 company.This position is full - time (40 hours /week), Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime.We offer 2 - 3 weeks of training. Training will be conducted virtually from your home.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Primary Responsibilities:

  • Research and resolves member complaints, grievances, appeals and provider appeals involving provision of service and benefit coverage issues, ensuring compliance with MCNA Grievance and Appeals policies and procedures
  • Ensure grievances and appeals has been categorized correctly
  • Prepare files for appeals to regulatory agencies
  • 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
  • Collaborate with internal departments, such as, Member Services, Provider Relations and Dental Management departments with grievance and appeals
  • Communicate appeal or grievance information to members or providers and internal / external parties within the required timeframes 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 prior authorization or claims processing details. You'll also need to effectively draft correspondence that explains the grievance or appeal 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 higher) OR equivalent years of work experience
    • 2+ years of experience in customer service in a managed care environment OR medical office OR health insurance
    • 1+ years of Managed care experience, Medicaid grievance OR appeals experience
    • Experience in working with Microsoft Word (creating and editing documents) and Microsoft Excel (creating and updating spreadsheets)
    • Ability to work any 8-hour shift between the hours of 8:00 AM - 5:00 PM including the flexibility to work occasional overtime based on business needPreferred Qualifications:
      • Experience with health care, medical, OR dental terminology
      • Bilingual fluency in English and any other languageTelecommuting 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 serviceSoft Skills:
          • Strong written communication skills including advanced skills in grammar and spelling
          • Ability to navigate and learn new and complex computer system applicationsUnitedHealth 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 https://uhg.hr/transitioning-militaryLearn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vetCareers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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 , Appeals Representative - Central Region - Remote, Other , Hartford, Connecticut

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