Senior Appeals Representative - Remote in AZ

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together. 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 determining 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 (6:00am - 5:00pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at Arizona. This will be on the job training and the hours during training will be 6am to 5pm, Monday – Friday. If you are located in Arizona, you will have the flexibility to work remotely* as you take on some tough challenges. 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 information to members or providers and internal/external parties within the required timeframes

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
• Must be 18 years of age or older
• 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
• Ability to work 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 (6:00am - 5:00pm). It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• Presently employed within UHC Operations & Experience. Those currently employed outside that unit will not be considered. (To verify, review your Sparq profile and the organization chart. Sparq Homepage, click “My Profile”, click “Organization Chart”. Look upward on the org chart to confirm that you report through Ops & Experience, and Mike Baker)

Telecommuting Requirements:

• Reside within Arizona
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• 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
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 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. #RPO #RED Apply Job!