Appeals Representative

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. This position is full-time Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

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.

High School Diploma / GED OR equivalent years of work experience Must be 18 years of age OR older 1+ years of experience with analyzing and solving customer problems 1+ years of experience working in a remote environment Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications Experience with Microsoft Word (create correspondence and work within templates) and Microsoft Outlook (email and calendar management) Ability to work between the hours of 7:00 am - 5:00 pm MST from Monday - Friday Preferred Qualifications: Experience with health care, medical, OR pharmacy terminology Experience working with Microsoft Excel (data entry, sort / filter, and work within tables) Telecommuting Requirements: 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 with advanced proficiency in grammar and spelling *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of