Work from home while helping members get fair decisions on their health care claims. As a Sr Appeals Representative with UnitedHealth Group, you will dig into complex appeals and grievances, resolve written complaints, and make fact based decisions that directly impact people’s access to care.
About UnitedHealth Group
UnitedHealth Group is a global health care organization focused on helping people live healthier lives and making the health system work better for everyone. Through UnitedHealthcare and Optum, they support millions of members, providers, and communities with data driven care and benefits solutions. The company is committed to equity, affordability, and innovation across the health care system.
Schedule
Full time, 40 hours per week.
This role is National Remote, with the flexibility to telecommute from anywhere in the United States.
Department operates Monday through Saturday, 7:00 a.m. to 7:00 p.m. Eastern Time, with an assigned 8 hour shift within that window.
Six weeks of paid virtual training, Monday through Friday, 8:00 a.m. to 4:30 p.m. Eastern Time.
Department is open 365 days a year, so some holiday coverage may be required based on business needs.
What You’ll Do
⦁ Research and resolve written complaints submitted by consumers, physicians, and providers, ensuring cases are categorized and handled correctly.
⦁ Obtain and review additional documentation needed for appeals and grievance case review.
⦁ Determine when clinical review is required and route cases appropriately.
⦁ Render decisions on non clinical complaints using sound, fact based judgment aligned with policies and regulations.
⦁ Document final appeal and grievance determinations using the appropriate templates and internal systems.
⦁ Communicate appeal or grievance outcomes to members, providers, and internal or external parties within required time frames.
⦁ Serve as a subject matter resource on regulatory guidelines, privacy policies, and claims processing details for your team.
What You Need
⦁ High school diploma or GED, or equivalent work experience.
⦁ At least 2 years of experience analyzing and resolving appeals and grievances in an office environment using phone and computer tools, or 2 years of experience in a health care setting with knowledge of the medical claims or billing process.
⦁ Strong proficiency with Microsoft Word for creating and editing documents, and Microsoft Excel for data entry and basic formatting.
⦁ Comfort navigating multiple computer systems and learning new, complex applications.
⦁ Ability to work a full time 40 hour schedule, Monday through Saturday, with an assigned 8 hour shift between 7:00 a.m. and 7:00 p.m. Eastern Time.
⦁ Strong written communication skills, including solid grammar and spelling, plus the ability to handle multiple products and benefit levels.
Benefits
⦁ Competitive hourly pay range from 20.00 to 35.72 dollars per hour based on experience, location, and internal equity.
⦁ Comprehensive benefits package that may include medical, dental, vision, and other health coverage options, subject to eligibility.
⦁ Incentive and recognition programs, equity stock purchase opportunities, and 401(k) contribution.
⦁ Six weeks of paid training and ongoing development, with potential to grow into new roles within the organization.
⦁ Remote work with a telecommuter policy that supports a secure, private home based work environment.
This role will close once a strong candidate pool is reached, so if the schedule and responsibilities fit your background, get your application in soon.
If you are detail oriented, strong with written communication, and ready to use your appeals experience to advocate for fair outcomes from home, this could be a powerful next step in your career.
Happy Hunting,
~Two Chicks…