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 10 company leader in healthcare. We did it by working to become an undisputed leader in creating service quality 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 great training, support and opportunities.

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 (8:00am - 4:00pm 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:

• 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 informa tion 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 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 higher) OR equivalent work experience
• 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
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

Preferred Qualifications

• Knowledge of CPS FACETS
• Knowledge of Appeals Process
• Knowledge of the individual & Family Plans Business

Telecommuting 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 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

UnitedHealth 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-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with UnitedHealthcare . Let's talk about opportunity. Start with a Fortune 5 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. SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $18.17 - $32.26. The salary range for Connecticut / Nevada residents is $20.00 - $35.53. 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.

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