Appeals Representative Associate

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. UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth. Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career. The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. 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 8:00 am - 5:00 pm in your time zone. It may be necessary, given the business need, to work occasional overtime. We offer up to 6 weeks of paid training. The hours during training will be 7:00 am - 3:00 pm CST, Monday - Friday.

Research and resolve written complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers. Communicate with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyze and identify trends for appeals and grievances. Apply knowledge/skills to basic, repeated activities. Respond to standard requests and solve routine problems by following established procedures. Work with others as part of a team and have work reviewed by others. 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 work experience Must be 18 years of age OR older 1+ years of experience analyzing and resolving customer issues, or equivalent experience in an office, administrative, clerical, or customer service environment using phone and computer systems as primary tools Experience with Microsoft Word (create, edit, format documents) and Microsoft Excel (create, edit, format spreadsheets) 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 8:00 am - 5:00 pm in your time zone. It may be necessary, given the business need, to work occasional overtime Preferred Qualifications: 2+ years of medical claims experience Experience with Healthcare/Medicare Terminology Managed Care and Appeals/Grievances experience 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. *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