Senior Appeals Representative - Remote in Hawaii
Company: UnitedHealth Group
Location: Honolulu
Posted on: May 24, 2023
Job Description:
If you are located within Hawaii, you will have the flexibility
to telecommute* (work from home) as you take on some tough
challenges. -At UnitedHealthcare, we're simplifying the health care
experience, creating healthier communities, and removing barriers
to quality care. The work you do here impacts the lives of millions
of people for the better. Come build the health care system of
tomorrow, making it more responsive, affordable, and equitable.
Ready to make a difference? Join us and start doing your life's
best work.SMThis 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 also need to effectively draft
correspondence that explains the claim resolution/outcome as well
as next steps/actions for the member.This position is full-time (40
hours/week) Monday - Saturday. Employees are required to have
flexibility to work any of our 8-hour shift schedules during our
normal business hours of 8:00am - 5:00pm. It may be necessary,
given the business need, to work occasional overtime, evenings, and
weekends.We offer 12 weeks of paid training. Training will be
conducted virtually from your home.*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/providersEnsure
complaint has been categorized correctlyObtain additional
documentation required for case reviewReview case to determine if
review by clinician is requiredRender decision for non-clinical
complaints using sound, fact-based decision makingComplete
necessary documentation of final appeals or grievance determination
using appropriate templatesCommunicate appeal or grievance
information to members or providers and internal/external parties
within the required timeframesYou'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 years of work experience1+ years of experience
analyzing and solving customer problems OR 1+ years of work
experience in a related environment (i.e., office, administrative,
clerical, customer service, etc.) using phones and computers as the
primary job toolsProficiency with computer and Windows PC
applications, which includes the ability to navigate and learn new
and complex computer system applicationsAbility to work full-time,
Monday - Saturday during our normal business hours of 8:00am -
5:00pm. It may be necessary given the business need to work
occasional overtime, evenings, and weekends.Preferred
Qualifications:
Experience with health care, medical,
or pharmacy terminologyTelecommuting Requirements:
Reside within HawaiiRequired to have
a dedicated work area established that is separated from other
living areas and provides information privacyAbility 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
serviceSoft Skills:
Strong written communication skills
including advanced skills in grammar and spellingCareers with
UnitedHealthcare. Work with a Fortune 5 organization that's serving
millions of people as we transform health care with bold ideas.
Bring your energy for driving change for the better. Help us
improve health access and outcomes for everyone, as we work to
advance health equity, connecting people with the care they need to
feel their best. As an industry leader, our commitment to improving
lives is second to none.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 #YELLOW
Keywords: UnitedHealth Group, Honolulu , Senior Appeals Representative - Remote in Hawaii, Other , Honolulu, Hawaii
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